SACM - United Kingdom
Permanent URI for this collectionhttps://drepo.sdl.edu.sa/handle/20.500.14154/9667
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Item Restricted Walking the Talk: Bridging Policy and Reality in Urban Walkability(University College London, 2024-09) Fatany, Sarah Waddah; Cavoli, ClemenceThis study explores the policy-reality gaps in improving walkability in the cities of Freetown and Maputo, with a focus on informal settlement communities. The study employs a qualitative approach in analysing policy documents and interview transcripts with residents and other stakeholders to try shape the understanding of the lived experience with walking. The findings reveal a huge contrast between policy intentions and the lived realities in informal settlements. The extent of acknowledging walking as a legitimate mode of transport is frustratingly low, despite walking being the most used form of mobility. The little attention given to walkability in both cities also fail to translate into tangible improvements in overall safety, accessibility, and pleasurability experiences of pedestrians. While policies acknowledge the lack of safety and access for pedestrians, they fail to acknowledge the comfort and ease of walking for pedestrians. The study highlights the marginalization of the urban poor communities that rely on walking as a mode to access services, jobs, and other opportunities. Calling for a shift in policymaking to prioritize pedestrian needs first. Which acts as an equalizing mode, contributing to reducing inequalities.18 0Item Restricted Self-Management Interventions To Improve Mobility In The Community Post-Stroke(Saudi Digital Library, 2023-05-18) Sahely, Ahmad; Rosewilliam, SheebaIndividuals’ lives after stroke are affected by multiple levels of disability. Appropriate rehabilitation services can help them to regain their functions and improve their quality of life. In the UK and other developed countries, there has been a tendency toward the early supported discharge from hospital after a stroke with the aim of providing care at home after discharge. However, stroke survivors’ needs after discharge from the hospital have been unmet as the health care services lack sufficient resources. Self-management strategies have been developed to help stroke survivors improve their self-efficacy and independence and play an active role in their rehabilitation process. The efficacy and appropriateness of self-management as an additional component to the current practice have been examined in several contexts, but there has been limited research around self-management strategies to improve mobility after stroke. The overarching aim of this thesis was to develop, implement, and test the feasibility of a self- management (SM) intervention to improve functional mobility for stroke survivors in the community. Chapter 1 (the introduction) provides a background of the research problem and the knowledge to practice gap. It demonstrates the prevalence, impact, and management of stroke with focus on mobility rehabilitation as a main physical impairment. It also discusses the gap in current practice regarding the delivery of optimum amount of therapy and the role of SM in bridging the gap and facilitating the recovery of stroke survivors. Chapter 2 demonstrates the philosophical stance taken by the researcher to select the appropriate methodology for each stage of this research work. It shows the advantages of applying different methods to address the specific objectives of the thesis. Chapter 3 includes a systematic review of the evidence about specific SM interventions that can be applied for the rehabilitation of mobility post-stroke. A new intervention was then developed in consultation ii with senior clinicians and stroke patients to adapt the use of evidence to a local context of stroke rehabilitation within the West Midlands. In study 2 (chapter 4). A qualitative exploratory study was carried out during the Covid-19 pandemic exploring needs and experiences of stroke patients and NHS therapists who worked with stroke patients with a special focus on the utility of self-management strategies post discharge. This study found four main themes that described the modifications in the care system because of the pandemic, impact on the stroke survivors at different stage, needs and priorities of stroke rehabilitation, and management strategies that have been used in stroke rehabilitation. The findings from the study contributed to the modification of the intervention developed to integrate technology and promote remote strategies for self-management. Study 3 (chapter 5), aimed to evaluate feasibility of implementation, to explore participants’ perspectives about the acceptability, practicality, and fidelity of the new intervention and to scope out methodological feasibility of a future randomised control trial of the new self-management intervention for mobility following stroke (SIMS). A mixed-methods study design was carried out including a feasibility randomised control design and focus groups to collect data. The study recruited 24 participants (14 males: 10 females; age range (36-87 years)) into both the intervention and control groups. The study findings showed that it was feasible to recruit participants from hospital and community, but the rate was low due to effects of the COVID-19 pandemic. Randomisation and blinding were successful. Retention rate was 83% at 3 months and 79.2% at 6 months assessments. Adherence to the intervention varied mainly due to post stroke fatigue, COVID-19 and the impact of mood changes. It was feasible to deliver the intervention online with no serious events related to the study. Focus groups discussed participants’ motivations for joining the programme, their perspectives on the intervention (fidelity and acceptability) and methodology, perceived improvements in walking outcomes, facilitators and challenges for self-management, and suggestions for improvement. Lastly, chapter 6 provides a summary of findings and discussion points about the key findings from all three studies included in this thesis work.23 0