| Ⅰ Purpose and Significance of the studyAccording to the2002edition for "the Classification and Terminologies of Assistive Devices for Persons with Disabilities" of the national standard, assistive device for the disabled is defined as "any product, device, equipment or system that is used for prevent, compensate, monitor, relief and reduce disabilities by disabled people". The supply of assistive device is one of the effective and direct methods for disabled people to compensate and improve performance, improve living quality and increase their capability of participating in social activities. And assistive devices play an irreplaceable role in the rehabilitation, education, employment and daily life of disabled people, which significantly promoting the realization of "Rehabilitation Service for Every Disabled People".From2008, Shanghai started the exploration of combination of assistive devices supply and home adaptation as a new type of assistive devices services. This policy provides one or several assistive devices and home adaptation for the local disabled citizens. But to answer the questions such as whether this intervention was effective and whether the disabled people got the expected welfare, we need to evaluate the effect of the program in order to improve policy for further development of assistive device services.Ⅱ Materials and MethodsThis research employed "Scientific Policy-making Procedures" and the principle of "Structure-Procedure-Result" as the leading research methods, with the combination of qualitative and quantitative methods, in order to evaluate the effect of the program, analyze and address with the factors that affected the policy and further the assistive device services.We collected materials by reviewing literature and related policies, field survey, key insider interview, group interview and material update analysis methods. The field survey investigated the disabled people in Zhabei district who received the service of assistive devices and home adaptations in2010. We collected materials during field survey with the MOS36-item short form health survey, the Social Support Rating Scale, the Barthel Index and the burden of family caregivers scale and other items. This research interviewed the specialist in this field, the officers, the evaluating doctors, the rehabilitation instructors and disabled people.Ⅲ Key Findings1. Resource allocation of the programZhabei District has a sound policy environment for the program. It has established the organization platform encompassing assistive devices management, technical guidance and assistive device services. It owns adequate staff including management personnel, community rehabilitation instructors, associated workers for the disabled, evaluating doctors and so on. Besides, this program has adequate financial and material support.2. Implementation process of the programIn the needs assessment phase,85.29%of people with disabilities were acknowledged of this program through working staffs of the streets(town); associated workers in charge of screening objects enrolled in the policy screened a total of105persons; the completion rate of needs application form was partly low.In the functional assessment phase, the completion rate of assessment items were comparatively high for19visually impaired persons and86physically challenged persons, while the completion rate of assessment items for home adaptation assessment items was low.In the service follow-up period, the management mechanism needed further clarification.3. Effects of the programAfter the implementation of the program,67in68disabled people received assistive devices (98.53%) with overall number of164, and the normal utilization ratio of devices was79.88%;25in68disabled people (36.76%) received the home adaptation with overally38changing projects.The benefits brought by the program:using the paired T-test, the total score of SF-36of the disabled people improved from39.97±18.64to60.08±18.28, up by20.11points with statistically significance; the total score of SSRS changed from31.09±7.05to30.46±7.04, decreasing by0.63points with no statistically significance; the total score of the Barthel Index remained almost the same at65.29, but the performance of daily activities of the disabled people were improved; the burden of family caregivers was eased to a certain extent.The satisfaction towards the program:64disabled people (94.12%) were satisfied with overall effect of the program. Using the Chi-square test and Oneway ANOVA, we found that the overall satisfaction rate of disabled people was not statistically associated with the number of received assistive devices, the number of assistive devices in usage, whether conducted residential modification, nor associated with the score of SF-36, SSRS and the Barthel Index of the disabled people.IV Discusions and SuggestionsAfter the implementation of the program, the quality of life for people with disabilities was improved, the identity and satisfaction towards the program was comparatively high. However, there are also problems as follows:inefficient staff working mechanism, undefined screening standards, lack of integrity of the assessment content, limited categories of assistive devices and home modifications, delayed implementation, unavailable follow-up services and other issues. Based on the above issues, this study employed root cause analysis method and proposed the following suggestions:①a sound service system for the program is needed to build up, including strengthening personnel training, establishment of third-party evaluation mechanism and improvement of the information technology;②services of each step in the implementation process and one-stop service shoud be provided and optimized, which includes expansion of propaganda, strict screening standards, sound assesment criteria and content, expanded range of devices and modifications, more personalized adaptation, establishment of follow-up mechanism to enhance the applicability of aids. |
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