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 Table of Contents  
Year : 2020  |  Volume : 14  |  Issue : 1  |  Page : 37-40

Development of training manuals for community disability workers

1 Department of Community Based Rehabilitation, JSS College of Physiotherapy, Mysore, Karnataka, India
2 Department of Physiotherapy, Sikkim Manipal University, Gangtok, Sikkim, India
3 Centre for Health, Activity, and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
4 Independent Practitioner (PT), Bengaluru, Karnataka, India

Date of Submission27-Aug-2019
Date of Decision12-Feb-2020
Date of Acceptance26-Mar-2020
Date of Web Publication29-Jun-2020

Correspondence Address:
Dr. Kavitha Raja
JSS College of Physiotherapy, Mysore - 570 004, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/PJIAP.PJIAP_19_19

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BACKGROUND: People with disability (PWD) living in the community often require ongoing assistance for self-care and for continuing rehabilitation maintenance programs. While awareness material is easily available, training for volunteers working with disabled population and family members of PWD is hard to come by.
AIM: The aim of this study was to develop resource material for training of disability workers, community-based rehabilitation (CBR) workers, and school teachers in rural areas in specific areas.
METHODOLOGY: Using standard guidelines, training manuals were prepared under five specific categories to train CBR volunteers to undertake routine maintenance exercise programs and functional training strategies. These manuals were translated into Kannada, and in stepwise process fieldworkers, school teachers and CBR workers were trained. Revisions were made based on feedback received from stakeholders.
RESULTS: Five manuals pertaining to specific areas have been prepared and tested.
CONCLUSION: The training manuals developed for CBR workers are available in English and Kannada and were found to be useful by the target population in this preliminary study.

Keywords: Community-based rehabilitation training, community-based rehabilitation workers, persons with disabilities

How to cite this article:
Raja K, Gupta S, Mathew J, Rao P. Development of training manuals for community disability workers. Physiother - J Indian Assoc Physiother 2020;14:37-40

How to cite this URL:
Raja K, Gupta S, Mathew J, Rao P. Development of training manuals for community disability workers. Physiother - J Indian Assoc Physiother [serial online] 2020 [cited 2022 Jun 30];14:37-40. Available from: https://www.pjiap.org/text.asp?2020/14/1/37/288360

  Introduction Top

People with disability (PWD) living in the community often require ongoing assistance for self-care and for continuing rehabilitation maintenance programs. While awareness material is easily available, training for volunteers working with disabled population and family members of PWD is hard to come by. Moreover, available resources are often inadequate in scope for the specific requirements of people living with chronic illness or disability in the community in India. The commonly available training material has been developed by the World Health Organization (WHO), United Nations Educational, Scientific and Cultural Organization (UNESCO), and other arms of the united nations.[1],[2]

A review of training manuals from the WHO, community-based rehabilitation (CBR) guidelines, Childhood Disability Information Kit from UNESCO,[3] and CBR training manual from light of the world[4] revealed that they had limited information and were rarely specific to conditions. Due to the lack of condition-specific information, the community worker would be required to use reasoning to identify what exercises/techniques were to be taught to the individual patient.[5] This is often beyond the training and understanding of casual community workers. Hence, the need for India-specific manuals with focus on specific functional deficits was envisioned.

An initial survey of literature and of a sample village in Udupi district revealed that the main areas of training that PWD and caregivers identified were as follows:

  • Fitness programs in older people and prevention of falls
  • Management of arthritis
  • Ability training of disabled.

Management of arthritis feedback received from parents and school teachers resulted in two more areas of need being identified.

  • Child with special needs
  • Childhood fitness.

Thus, the objective of this study was to develop resource material for training of disability workers, CBR workers, and school teachers in rural areas in the areas identified above.

  Methodology Top

The resource material was developed using a multistep process as follows:[4]

  1. Development of resource material
  2. Testing on fieldworkers
  3. Revision
  4. Face validation
  5. Testing on target population
  6. Revision and finalization.

Development of resource material

Three volunteers and the authors developed specific manuals for each of the identified areas, thus generating five books which cover the following areas:

  1. Training manual for fitness programs in older people and prevention of falls
  2. Training manual for management of arthritis
  3. Training manual for ability training of disabled
  4. Training manual for a child with special needs
  5. Training manual for childhood fitness.

Of the five books, the first three were meant for training CBR workers. The last two were meant for training the school teachers. Each manual was given to two professionals who gave their feedback and suggestions which were incorporated into the manual. Each manual was translated and proofread in Kannada. The person who translated the manual and the one who proofread it for accuracy were both bilingual. The flow of activities is depicted in [Figure 1].
Figure 1: Procedure adopted for development of training manuals

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  Results and Discussion Top

Testing on fieldworkers

Once the materials were prepared, two fieldworkers who were part of the CBR team of the department were trained on how to use the manual. Their feedback was obtained using interview method. The fieldworkers found the manuals too elaborate. They found it difficult to remember all the training manuals and grasp it thoroughly. Based on the inputs received from the fieldworkers, we decided to train each identified CBR workers on specific training manuals.

Using this strategy, the identified CBR workers were trained. Two CBR workers were identified, and they were trained by dividing the five manuals into two related components, namely the first two manuals to one worker and the third to another. Following this, feedback was obtained using interview method.

Revision and consolidation of manual

Based on the inputs from the fieldworkers and the CBR workers, the material was revised to make it easier to understand. Some subcomponents which were not addressed in the previous manuals were added to improve flow and enhance understanding.

Face validation of manual

A copy of each manual was given to professionals who had not been involved in developing the material. Based on the inputs from the staff, the manuals were edited. The edited manuals were then tested on three laypersons to understand ability, clarity, and applicability. Based on the inputs from them, with respect to the content, clarity, and the language, the necessary modifications were made in the manuals. Inputs were also taken from the CBR workers, and the necessary changes were made in terms of language and understanding. Supplementary audio-visual information was provided to improve the clarity. It is recommended that these be used during training.

Testing on target population

Five CBR workers identified earlier who had not been part of the earlier phase were trained, and their feedback was obtained on the feasibility of using the manuals. They were eager to procure copies of the manuals. This indicates the usefulness of the manuals. Furthermore, the utility and understandability of the material was evaluated based on the CBR workers' opinion. When it comes to utility aspect, only three CBR workers actually performed what was expected from them. Of the three, the worker who was a new volunteer performed better than the other two who were Accredited Social Health Activist (ASHA) workers. The reason could be that they had to do their regular work and CBR work simultaneously which they had difficulty in coping with. Most of them voiced that they would not be able to do both duties simultaneously.

When questioned, the CBR workers considered the work given to them as feasible. Half of them felt that it was not feasible to form groups in the community for performing exercises and continue performing it for a longer period of time. They also believed that it would be difficult to track the activities of the CBR workers for a longer period of time. Most of them felt that they would have been able to perform the activities better if more time was given to them. Moreover, weather conditions impaired their work to quite an extent.

Evaluation of learning

A pretest was administered before the training session and a posttest after completion. The difference in scores of the two tests was taken as an indication of the level of learning. The level of learning that was required was set at 80%–85% to consider the fieldworker qualified to undertake training. The performance of the fieldworkers is depicted in [Figure 2].
Figure 2: Change in test scores of the community-based rehabilitation workers

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Of the five CBR workers, two had no difference in their pre- and posttest readings. Their prior knowledge was high to begin with. The other three workers showed improvement in their knowledge compared to their pretest status. One CBR worker had her posttest value at 60%. The expected level of understanding as per the training manual was considered as 80%–85%. However, this worker seemed to be very enthusiastic, had a willingness to learn, and also had a lot of contacts locally. Hence, we decided to go ahead and train the worker again. Additional training elicited an improvement in performance.

Of all the CBR workers trained, only one worker actually trained people. This person was the only disabled worker that we had trained. He identified many patients. Of all the patients that he approached, only three were convinced to come together to perform the exercises in a group. Of these, all had complaints of joint pains. The CBR worker could train them for a period of 2 weeks following which the patients were noncompliant. An evaluation of these three patients was done by the fieldworkers to evaluate their perception about the training, the trainer, and the feasibility. All of them agreed that they were trained on activities that would benefit them. All understood the training and found the training given adequate. Two of them felt that more training sessions were required. In the instance that they forgot information, all of them brought it to the notice of the CBR worker who taught them again. Two of them felt that it was feasible to perform the activities at home. All of them said that the CBR worker followed up on the progress that they made each week. Two of them felt that they could continue doing the exercises as it would benefit them and opined that they would want to participate in similar such programs in the future.

Two of the CBR workers, who were ASHA workers, had to juggle their work and the project work. As the project coincided with the monsoon, this was a major challenge in the workers being able to complete their jobs. General apathy among the community and a general attitude of drug dependence rather than alternative therapies was a major deterrent in patients' interest in the programs. A longer period of time is required to change this attitude. This finding has been reported by previous authors on the attitudes of older people toward PWD in India.[6]

Disabled individuals as CBR workers can be considered as an option. This will allow integration of the disabled person into the community and also empower him/her by providing livelihood. This may also be a step toward forming self-help groups and advocacy. People can relate better if disabled individuals train them as they will consider the exercises doable. Individuals with no experience in health-related activities can be considered as CBR workers. A background of health-related work is not essential.

Regarding the manuals for teachers, teachers in two local schools were trained. The physical education teachers were interested and appreciative of the manuals. Although physical education curriculum is given as a manual to schools following the Central Board of Secondary Education curriculum, such a system is not currently present in the government schools. Hence, the teachers were appreciative about the fitness manual. In the scenario of inclusive education, the manual of special children was also appreciated by teachers.

Community-based programs to improve childhood health and fitness has been suggested by previous authors in a large study.[7],[8] This need is expected to be partly fulfilled by this study. The manuals in English and Kannada are available with the authors on request free of charge.

  Conclusion Top

The training manuals developed for CBR workers are available in English and Kannada and were found to be useful by the target population in this preliminary study.

Financial support and sponsorship

This study is an offshoot of a project funded by WHO, India WHO Regn 2011/138001-0, and was partly conducted under the aegis of Department of Physiotherapy, Manipal College of Allied Health Sciences, Manipal, and partly under JSS College of Physiotherapy, Mysuru.

Conflicts of interest

There are no conflicts of interest.

  References Top

Thomas M, Thomas MJ. Manual for CBR planners. Asia Pac Disabil Rehabil J 2003; 1:1-88.   Back to cited text no. 1
Wirz S. Training of CBR personnel. Asia Pac Disabil Rehabil J 2000; 2:100-12.   Back to cited text no. 2
Houtrow AJ, Larson K, Olson LM, Newacheck PW, Halfon N. Changing trends of childhood disability, 2001–2011. Pediatrics. 2014;134:530-8.  Back to cited text no. 3
Robb A. Report on “Technical Meeting on Development of CBR M&E” and the 1st CBR World Congress; 2012. p. 26-8.  Back to cited text no. 4
Robertson J, Emerson E, Hatton C, Yasamy MT. Efficacy of community-based rehabilitation for children with or at significant risk of intellectual disabilities in low- and middle-income countries: A review. J Appl Res Intellect Disabil 2012;25:143-54.  Back to cited text no. 5
World Health Organization. Information, education and communication: A guide for AIDS programme managers. WHO Regional Office for South-East Asia; 2000.  Back to cited text no. 6
Bakheit AM, Shanmugalingam V. A study of the attitudes of a rural Indian community toward people with physical disabilities. Clin Rehabil 1997;11:329-34.  Back to cited text no. 7
Ranjani H, Pradeepa R, Mehreen TS, Anjana RM, Anand K, Garg R, et al. Determinants, consequences and prevention of childhood overweight and obesity: An Indian context. Indian J Endocrinol Metab 2014;18 Suppl. S1:S17-25.  Back to cited text no. 8


  [Figure 1], [Figure 2]


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