Community mobility: psychosocial experiences of stroke survivors who use wheelchairs in Worcester, South Africa

Abstract

Background: Despite policies promoting transport inclusivity, persons with disabilities in South Africa experience difficulties when accessing public transport. Poor community mobility hampers community integration and participation in occupations outside the home. This article describes the psychosocial community mobility experiences, of stroke survivors using wheelchairs in a town in the Western Cape province of South Africa.

Method: The study used a descriptive qualitative design. The study population were community dwelling stroke survivors, from Worcester, using wheelchairs. Data was collected from eight participants through semi-structured telephonic interviews. Inductive thematic analysis was used.

Findings: The four themes derived from the data were: Freedom of movement (My power chair, my Ferrari’), Social anxiety (People stare at you like they do not have a heart), Dependency (I must dance along to his fiddle), and Social isolation (You feel done in, dejected). Participants identified wheelchairs, private vehicles, and mini-bus taxis as modes of community mobility. Conclusion: When transport barriers prevent dignified, spontaneous community integration negative psychosocial consequences (social anxiety, dependency, and social isolation) followed. Community mobility barriers hampered participants’ ability to participate in meaningful occupations and left them isolated. Occupational therapists should take cognisance of the community mobility challenges wheelchair users might experience and implement intervention strategies to mediate these. Implications for practice • Community mobility is essential to perform occupations outside the residential setting and must be included in occupational therapy assessment and intervention strategies. • Occupational therapists can empower individuals with mobility impairments with the life skills to manage psychological challenges caused by accessing public transport and decreased community mobility. • Occupational therapy intervention for wheelchair users accessing public transport should include effective, appropriate transfer strategies to embark and disembark from minibus taxis. • In certain circumstances the occupational therapist should consider the possibility of a motorised wheeled mobility device to facilitate community integration: The study used a descriptive qualitative design. The study population were community dwelling stroke survivors, from Worcester, using wheelchairs. Data was collected from eight participants through semi-structured telephonic interviews. Inductive thematic analysis was used. Findings: The four themes derived from the data were: Freedom of movement (My power chair, my Ferrari’), Social anxiety (People stare at you like they do not have a heart), Dependency (I must dance along to his fiddle), and Social isolation (You feel done in, dejected). Participants identified wheelchairs, private vehicles, and mini-bus taxis as modes of community mobility.

Conclusion: When transport barriers prevent dignified, spontaneous community integration negative psychosocial consequences (social anxiety, dependency, and social isolation) followed. Community mobility barriers hampered participants’ ability to participate in meaningful occupations and left them isolated. Occupational therapists should take cognisance of the community mobility challenges wheelchair users might experience and implement intervention strategies to mediate these.

Implications for practice

• Community mobility is essential to perform occupations outside the residential setting and must be included in occupational therapy assessment and intervention strategies.

• Occupational therapists can empower individuals with mobility impairments with the life skills to manage psychological challenges caused by accessing public transport and decreased community mobility.

• Occupational therapy intervention for wheelchair users accessing public transport should include effective, appropriate transfer strategies to embark and disembark from minibus taxis.

• In certain circumstances the occupational therapist should consider the possibility of a motorised wheeled mobility device to facilitate community integration