Quality of Occupational Therapy Research in India - A Descriptive Review

Background: Occupational therapy (OT) enhances functional independence in the daily activities of people with disabilities and subsequently their quality of life. Research in OT generates evidence to provide safe and effective services to the disabled. However, OT research in India has been shown to have various methodological limitations. These methodological limitations are expected to impact the quality of OT research as well as the evidence derived from this research to inform decision‑making in rehabilitation. The majority of the OT research is disseminated and promoted through the All India Occupational Therapists’ Association’s (AIOTA) annual national conference (ANC). Analyzing the abstracts, selected for the presentation at the ANC could help understand and strategically improve the quality of OT research in India. Objectives: To explore and describe the quality of OT research in India. Study Design: Descriptive analysis. Methods: Descriptive, nonsystematic review and analysis of the key methodological aspects of the conference abstracts submitted for the AIOTA ANC published in the Indian Journal of OT (IJOT) from 2017 to 2021 was carried out. Information related to the methodological aspects of the research abstracts was extracted using a data extraction form and the data were synthesized and reported descriptively. Results: About 218 abstracts had been selected for either poster or oral presentations in the AIOTA ANC. All the abstracts were included for the review. A total of 8055 participants were recruited for the studies conducted from 2017 to 2021. About 5757 (72) of the participants were recruited for cross‑sectional studies. Nearly 72 (33) of the abstracts presented were related to cross‑sectional studies, 52 (24) were case studies and 66 (30) were experimental studies. However, research designs implying highest level of evidence such as systematic reviews were only 4 (2) and randomized controlled trials were only 9 (4) with 297 participants. Notably, 203 (98) of the all the studies evaluating effectiveness of interventions or aiming to investigate associations reported positive results with statistically significant improvements and associations. Conclusion: The review provides invaluable information relatedto the quality of OT research in India. It implies the need to improve the scientific rigor of the evidence generated in relation to OT research in India. This review also implies the need for a radical change and strengthening of OT research within OT education and professional practice in India. National and global OT associations need to prioritize good quality OT research by enhancing the research skills and competencies of OTs in India. This could help promote evidence‑based OT science and develop the OT profession in the world’s second‑most populous country. In addition, it is also expected to encourage those OT researchers who have been striving to build OT research standards in India

Knowledge, Attitude and Practices regarding tuberculosis among slum pockets of western Mumbai: a cross sectional study

Background: Tuberculosis (TB) is a major public health problem prevailing in the rural and urban areas of India. A study was conducted to assess the Knowledge, Attitude, and Practices regarding tuberculosis among slum pockets of western Mumbai. Material and methods: Cross sectional quantitative study conducted using a pre-validated WHO KAP questionnaire. Random walk technique stratified by daytime was used. Descriptive analysis and inferential statistics (Chi-square test) were used. Result: A total of 140 participants were interviewed. Knowledge received from friends, neighbors reported more (58%) in NCC and squatters colony as compared Ambujwadi (48.6%). People held compassion and desire to help people living with TB (59.3%), but only 1.4% participants had reported actual support to TB patients in need. Stigma of TB (80.0%) is one of the most difficult challenges which attributed to hiding of TB disease status. Almost all respondents agreed that people hide TB status because of “fear that people will avoid them”.BMC corporation hospital (82.9 %) is the first choice of health seeking among the study participants however only 7.9 % of people knew about DOTs. Gender (p<0.005) and educational status (p<0.05) were found significantly associated with the knowledge of TB. Conclusion: Knowledge towards tuberculosis within the population is poor. It suggests that specialized educational programs should be developed for community to promote awareness regarding TB. The findings regarding attitude and stigma indicate need to address “stigma related to TB” by health care facilitators and community people at the time of health education

Leprosy trends at a tertiary care hospital in Mumbai, India, from 2008 to 2015

Background: Leprosy remains an important cause of preventable disabilities. After the advent of multidrug therapy, new leprosy cases have come down dramatically. Despite this achievement, India, which contributes 60% of the global leprosy burden, faces some challenges to eliminate the disease, including active transmission in the community and delayed diagnosis of leprosy patients. Objectives: The objectives of the study were 1) to determine sociodemographic and clinical characteristics of newly diagnosed adults and children (less than 15 years) with leprosy and their trends over time (2008–2015) and 2) to describe the profile of surgical procedures among leprosy patients registered for reconstructive surgeries during 2006–2015. Design: Retrospective descriptive study was conducted involving a record review of new patients with leprosy registered in Vimala Dermatological Centre, Mumbai. Results: A total of 578 new leprosy cases were registered in the hospital during 2008–2015. There has been a steady increase in the trend of child cases (less than 15 years) registered in the facility (from 3% in 2008 to 18% in 2015), x 2=12.11, p<0.01. The majority of the patients (68%) were migrants of Uttar Pradesh and Bihar. Conclusions: Targeting children and migrants and ensuring early diagnosis and treatment initiation are essential components for leprosy elimination in an urban metropolis in India

Assessment of educational environment of midwifery students in Auxillary Nurse and Midwifery Institutes, Tamil Nadu – A descriptive study

Introduction: Tamil Nadu has a well-established public health-care delivery system with the Auxiliary Nurse and Midwifery (ANM) or Village Health Nurses. They learn and qualify for their job from ANM institutes and become the key field level functionary who interacts directly with the community. Their ability to provide quality community care is largely determined by the quality of ANM education they receive during their training. Hence, this study aimed to assess the perception of these students to facilitate a conducive educational environment. Methods: A descriptive study was carried out among 244 ANM students from across 10 randomly selected government ANM schools in Tamil Nadu. A self-administered Dundee Ready Educational Environment Measure (DREEM) questionnaire was used for assessment. The data was analyzed using EpiData. Results: Among the 244 students enrolled in the study, the mean (standard deviation) global DREEM score was 167.39 (±18.06). Student's academic perception was the highest (91%), followed by student's perception of atmosphere (84.2%), learning (84%), and teachers (83.5%), and the least average score was from student's social self-perception (74%). Conclusion: The study showed the nursing students' view on their academic learning environment as “more positive than negative,” Centers were also considered excellent, and this assessment would provide an useful guide into the areas that students felt “good” about, which should be reinforced and the weaker areas that need to be strengthened for better services

Development and validation of a scale to assess attitudes of health care providers towards persons affected by leprosy in southern India.

INTRODUCTION:Assessment of attitudes of health care professionals is important as negative attitude could constitute a major deterrent to care-seeking by persons affected by neglected tropical diseases (NTDs) such as leprosy. Leprosy continues to pose a major disease burden in India with an annual new case detection rate of 10.17 per 100,000 population. This paper reports on the development and validation of a culturally appropriate scale to measure attitude of health care providers (HCPs) towards persons affected by leprosy in Tamil Nadu, India. METHODOLOGY/PRINCIPAL FINDINGS:The Affective, Behavioural and Cognitive (ABC) model of attitudes guided the development of the scale. Steps in scale development included qualitative interviews and focus group discussions with medical officers and paramedical staff selected from high prevalence districts in Tamil Nadu, India which informed the development of the draft scale. Reviews of existing attitude questionnaires in related areas further contributed to scale development and together helped to generate a large pool of items which was then subjected to Thurston's scaling method for selection of items from this pool. Face and content validity were obtained, following which internal consistency and test, re-test reliability were assessed. Scaling exercise resulted in 11 items being discarded from an initial pool of 38, owing to the poor agreement among experts regarding relevance. Face and content validity were good with experts endorsing relevance and applicability of items. The intra-class correlation coefficient (ICC) for test re-test reliability of the 27 item scale was 0.6 (95% CI: 0.20-0.78) indicating marginal intra-class correlation. The overall Cronbach's alpha was 0.85 while the alphas for each of the affective and behavioural components was good at 0.78 and 0.69 respectively indicating a good degree of consistency and homogeneity between items but the alpha for the cognitive component was low at 0.53. CONCLUSIONS:The ABC model of attitudes guided the development of the scale, ensured a mix of 27 items tapping into the three domains of Affect, Behaviour and Cognition which best explained the attitude construct. With good validity and alphas for each of the affective, behavioural components and overall alpha estimates, this scale can be a valuable tool to provide accurate estimates of the true attitudes held by HCPs. This, in turn, would be useful to obtain insights for appropriate intervention programmes that would help change negative attitudes of HCPs towards persons affected by leprosy. With some adaptations, the scales can be validated for other NTDs as well

Exploring the research priorities for occupational therapy in India: A descriptive review

Background: Occupational therapists are considered an important workforce for the rehabilitation of persons with disabilities globally. However, in India, the profession is just beginning to gain recognition within the national and state-level systems for health care. One of the reasons for this could be the paucity of specific research related to the development of occupational therapy (OT) and its benefits to the health systems. Therefore, it is of immense public health importance to explore the priorities and gaps in OT research in India. A vast majority of the OT research in India is promoted and disseminated through the All-India Occupational Therapists Association (AIOTA) and its annual national conference (ANC). Objectives: The objective of this study is to descriptively review the conference abstracts of the AIOTA ANC published in the Indian Journal of OT (IJOT), an official publication of the AIOTA, from 2017 to 2021. Study Design: The study design was a descriptive, nonsystematic review. Methods: Review of the abstracts selected for the AIOTA ANC published in the IJOT from 2017 to 2021. A data extraction form was developed and used to synthesize data related to the clinical and demographic characteristics of OT research in India. Results: The search yielded 218 abstracts. State-level trends indicated that close to 85% of the research submissions were from four states and no submissions from the northeastern states until 2020. Nearly 60% of the abstracts were clinical research with OT interventions. About 40% of these research abstracts were related to pediatrics, followed by neurology (17%), musculoskeletal (15%), mental health (10%), and ergonomics and assistive technology (8%). There were 1%–2% of research abstracts submitted related to coronavirus disease-2019 (COVID-19) and geriatrics. About 85% of the research abstracts were related to impairment (39%), activity limitation (26%), and social participation (22%). Conclusion: This review highlights the need for diversifying the research in OT in India. This is particularly important in relation to expanding from selected states to pan-India research and development, especially in the northeastern states. Furthermore, the focus of OT research must move beyond impairments and approach disability from the biopsychosocial perspective. It is also very important to diversify the research in OT to areas that are of public health importance such as COVID-19, geriatrics, noncommunicable diseases, and rehabilitation in health systems. Priority setting for research in OT in India is an important implication of this review

“I Wasted 3 Years, Thinking It’s Not a Problem”: Patient and Health System Delays in Diagnosis of Leprosy in India: A Mixed-Methods Study

<div><p>Background</p><p>Worldwide, leprosy is one of the major causes of preventable disability. India contributes to 60% of global leprosy burden. With increasing numbers of leprosy with grade 2 disability (visible disability) at diagnosis, we aimed to determine risk factors associated with grade 2 disability among new cases and explore patients and providers’ perspectives into reasons for late presentation.</p><p>Methodology/Principal Findings</p><p>This was an explanatory mixed-methods study where the quantitative component, a matched case-control design, was followed by a qualitative component. A total of 70 cases (grade 2 disability) and 140 controls (grade 0) matched for age and sex were randomly sampled from new patients registered between January 2013-January 2015 in three districts of Maharashtra (Mumbai, Thane and Amaravati) and interviewed using a structured close ended questionnaire. Eight public health care providers involved in leprosy care and 7 leprosy patients were purposively selected (maximum variation sampling) and interviewed using a structured open-ended interview schedule. Among cases, overall median (IQR) diagnosis delay in months was 17.9(7–30); patient and health system delay was 7(4–16.5) and 5.5(0.9–12.5) respectively; this was significantly higher than the delay in controls. Reasons for delayed presentation identified by the quantitative and qualitative data were: poor awareness of leprosy symptoms, first health care provider visited being private practitioners who were not aware about provision of free leprosy treatment at public health care facilities, reduced engagement and capacity of the general health care system in leprosy control.</p><p>Conclusions</p><p>Raising awareness in communities and health care providers regarding early leprosy symptoms, engagement of private health care provider in early leprosy diagnosis and increasing capacity of general health system staff, especially targeting high endemic areas that are hotspots for leprosy transmission may help in reducing diagnosis delays.</p></div

Risk factors associated with grade 2 disability at diagnosis among adult new leprosy patients registered in Maharashtra, India (2013–15).

<p>Risk factors associated with grade 2 disability at diagnosis among adult new leprosy patients registered in Maharashtra, India (2013–15).</p

Patient pathway in Maharashtra, India (2013–15)—Themes associated with leprosy diagnosis delay.

<p>Patient pathway in Maharashtra, India (2013–15)—Themes associated with leprosy diagnosis delay.</p

Reasons for not consulting doctor at a public health facility immediately after notice of first symptom among new leprosy patients (grade 2 and grade 0 disability at diagnosis) registered in Maharashtra, India (2013–15).

<p>Reasons for not consulting doctor at a public health facility immediately after notice of first symptom among new leprosy patients (grade 2 and grade 0 disability at diagnosis) registered in Maharashtra, India (2013–15).</p