Project Details
Overview
Research question: Transforming community-based physical rehabilitation services in the Philippines through co-design; is this achievable?
Background: Physical rehabilitation programmes are urgently needed in the Philippines, as evidenced by the statistics for stroke. In 2014 it was estimated that about 500,000 Filipinos will be affected by stroke resulting in healthcare costs of up to $1·2 billion.[1] The age adjusted Death Rate for stroke is 130.85 per 100,000 of population; this ranks Philippines #22 in the world.[2] The Philippines’ healthcare system is largely private and in 54% of the population the cost of interventions are borne by out-of-pocket payments, with limited use of services by lower and middle-income groups. Rehabilitation is central to promoting independence, meaningful life goals and economic productivity. Although stroke unit numbers have risen recently from 2 in 1999 to nearly 50 in 2021,[3] they remain inaccessible to patients who live in remote areas. No established community-based care facilities in the Philippines exist, and qualified staff to deliver rehabilitation within the Philippines are scarce.
Aims: To co-design and implement a sustainable self-management community-based programme for physical rehabilitation, using stroke as the test-case, and evaluate its impact on self-management skills, patient well-being and self-efficacy.
Methods: A mix of methods, to co-design and implement a bespoke self-management programme, with contextualised training resources, within 3 targeted regions, for local health workers, supported by local people with stroke acting as village heroes. Informed by the Knowledge to Action (KTA) framework, and based on the ‘Bridges’ training programme, co-designed self-management tools used by rehabilitation providers to support self-management will be produced. This programme has been established in the UK and elsewhere, including Estonia. Normalisation Process Theory (NPT), alongside the KTA will be used to understand implementation, sustainability, and cost-effectiveness. We will adopt a pragmatic approach, facilitating co-production, tailoring, implementation and evaluation. These frameworks will enable us to capture necessary modifications ensuring that the evidence-based self-management programme for stroke rehabilitation has a pragmatic fit with the context of wider community health delivery in the Philippines.
Background: Physical rehabilitation programmes are urgently needed in the Philippines, as evidenced by the statistics for stroke. In 2014 it was estimated that about 500,000 Filipinos will be affected by stroke resulting in healthcare costs of up to $1·2 billion.[1] The age adjusted Death Rate for stroke is 130.85 per 100,000 of population; this ranks Philippines #22 in the world.[2] The Philippines’ healthcare system is largely private and in 54% of the population the cost of interventions are borne by out-of-pocket payments, with limited use of services by lower and middle-income groups. Rehabilitation is central to promoting independence, meaningful life goals and economic productivity. Although stroke unit numbers have risen recently from 2 in 1999 to nearly 50 in 2021,[3] they remain inaccessible to patients who live in remote areas. No established community-based care facilities in the Philippines exist, and qualified staff to deliver rehabilitation within the Philippines are scarce.
Aims: To co-design and implement a sustainable self-management community-based programme for physical rehabilitation, using stroke as the test-case, and evaluate its impact on self-management skills, patient well-being and self-efficacy.
Methods: A mix of methods, to co-design and implement a bespoke self-management programme, with contextualised training resources, within 3 targeted regions, for local health workers, supported by local people with stroke acting as village heroes. Informed by the Knowledge to Action (KTA) framework, and based on the ‘Bridges’ training programme, co-designed self-management tools used by rehabilitation providers to support self-management will be produced. This programme has been established in the UK and elsewhere, including Estonia. Normalisation Process Theory (NPT), alongside the KTA will be used to understand implementation, sustainability, and cost-effectiveness. We will adopt a pragmatic approach, facilitating co-production, tailoring, implementation and evaluation. These frameworks will enable us to capture necessary modifications ensuring that the evidence-based self-management programme for stroke rehabilitation has a pragmatic fit with the context of wider community health delivery in the Philippines.
Project Aims
Overall aim: To co-produce a self-management programme, using stroke as a case study, that can be delivered within community settings, by community workers, and provide an evaluation of the programme within community settings with the aim of wider application and adoption.
Objectives:
• To review current support available for rehabilitation in the Philippines against what is needed, assessing at micro, macro and meso levels the structure of rehabilitation, with a focus on stroke, and the extent of community delivery of care, generating quantitative and qualitative data that will inform the co-design stage (Work Packages (WP) 2 & 3).
• To co-design contextualised self-management programme to aid rehabilitation together with training resources available for delivery, within targeted regions, by Bridges champions; the barangay health workers. (WP 4)
• To establish metrics for monitoring changes in clinician self-management skills and in patient outcomes (WP4).
• To establish an implementation Stakeholder Steering Group that oversees longer-term sustainability of the project (WP4).
• To understand the barriers and enablers to successful implementation and scaling up of the model of training based on self-management that could be replicated in other areas and for other conditions (WP5).
• To submit an application to municipal and provincial health authorities for formal adoption of the TULAY self-management programme through ordinances (WP5).
The key research questions to be answered are:
1. What is the current overall capacity of physical rehabilitation services in terms of resources, staff numbers and skill mix?
2. What are the key factors that are determining the quality of the stroke rehabilitation services?
3. What are the specific needs of the Philippines when services are compared with the international gold standards in stroke rehabilitation services, and where are the gaps?
4. What are the components of a co-designed TULAY self-management programme for community-based rehabilitation?
5. Can local healthcare workers (municipal and barangay) be effectively trained to deliver a community rehabilitation programme?
6. What factors affect implementation of a community stroke rehabilitation programme?
As a result of this research, we will have co-designed a model for optimising stroke rehabilitation within the Philippines that is acceptable to patients, deliverable in community settings, supported by local and national authorities, and sustainable. This approach will serve as a model for rehabilitation of other long-term conditions within the Philippines and other LMICs and help to support actions associated with SDG3.4 and 3.8.
Objectives:
• To review current support available for rehabilitation in the Philippines against what is needed, assessing at micro, macro and meso levels the structure of rehabilitation, with a focus on stroke, and the extent of community delivery of care, generating quantitative and qualitative data that will inform the co-design stage (Work Packages (WP) 2 & 3).
• To co-design contextualised self-management programme to aid rehabilitation together with training resources available for delivery, within targeted regions, by Bridges champions; the barangay health workers. (WP 4)
• To establish metrics for monitoring changes in clinician self-management skills and in patient outcomes (WP4).
• To establish an implementation Stakeholder Steering Group that oversees longer-term sustainability of the project (WP4).
• To understand the barriers and enablers to successful implementation and scaling up of the model of training based on self-management that could be replicated in other areas and for other conditions (WP5).
• To submit an application to municipal and provincial health authorities for formal adoption of the TULAY self-management programme through ordinances (WP5).
The key research questions to be answered are:
1. What is the current overall capacity of physical rehabilitation services in terms of resources, staff numbers and skill mix?
2. What are the key factors that are determining the quality of the stroke rehabilitation services?
3. What are the specific needs of the Philippines when services are compared with the international gold standards in stroke rehabilitation services, and where are the gaps?
4. What are the components of a co-designed TULAY self-management programme for community-based rehabilitation?
5. Can local healthcare workers (municipal and barangay) be effectively trained to deliver a community rehabilitation programme?
6. What factors affect implementation of a community stroke rehabilitation programme?
As a result of this research, we will have co-designed a model for optimising stroke rehabilitation within the Philippines that is acceptable to patients, deliverable in community settings, supported by local and national authorities, and sustainable. This approach will serve as a model for rehabilitation of other long-term conditions within the Philippines and other LMICs and help to support actions associated with SDG3.4 and 3.8.
| Short title | TULAY project |
|---|---|
| Acronym | TULAY |
| Status | Active |
| Effective start/end date | 1/10/22 → 30/09/26 |
Collaborative partners
- University of Plymouth (lead)
- De La Salle University-Manila
UN Sustainable Development Goals
In 2015, UN member states agreed to 17 global Sustainable Development Goals (SDGs) to end poverty, protect the planet and ensure prosperity for all. This project contributes towards the following SDG(s):
