Community-Based Rehabilitation and Nursing Services in the Dominican Republic: A Program Evaluation

BACKGROUND: One in eight people in the Dominican Republic have a disability, and they face a multitude of barriers to education, employment, and healthcare. Comunidad Connect (CC), a nonprofit, seeks to serve this population through the provision of home-based healthcare in partnership with local organizations and U.S.-based nursing and rehabilitation students. OBJECTIVE: To evaluate the effectiveness of Comunidad Connect’s Together For Health program, as determined by staff, patient, and caregiver perspectives ACOTE Area: This capstone falls under the Accreditation Council for Occupational Therapy Education (ACOTE) area of program development and evaluation. Within the scope of this project, Comunidad Connect’s Together For Health program, including their follow-up rehabilitation service provision, was evaluated for effectiveness. METHODS: This program evaluation had four stages of data collection to determine staff, patient, and caregiver perceptions of the effectiveness of CC’s care provision. Staff perspectives were investigated through key-informant interviews and SWOT analysis. Patient perspectives were investigated through anonymous surveys on Qualtrics. Caregiver perspectives were investigated through a secondary analysis of survey data collected by CC. Data was collected over the course of six weeks and was analyzed through descriptive statistics and thematic analysis. RESULTS: Staff perspectives yielded three main themes: Overview of Together For Health, including general structure and function, patient recruitment and intake, and community partnerships; Impact of Student Groups, including benefit to the DR community, benefits to students, and challenges with students; and Sustainability of Impact, including follow-up care and challenges to sustainability. Patient perspectives yielded a variety of trends related to how patient satisfaction and patient improvement vary across different variables including age, condition, level of assistance, service type, and number of visits. Overall, 70% of patients report they are very satisfied with their care, yet 56.7% of patients report no improvement to their condition. Caregiver perspectives yielded multiple findings related to familial role (94% nuclear family member), specific challenges (financial and transportation limitations), social supports (70% lacking social support), and satisfaction with caregiving (90% very satisfied). Due to the small sample size, generalizations could not be made, but trends were identified for Comunidad Connect’s reference as they adapt to the needs of their population. CONCLUSIONS AND RELEVANCE: The results illuminated various perspectives on the effectiveness of Comunidad Connect’s Together For Health program, as well as areas for improvement. The findings suggest that Comunidad Connect’s population is highly satisfied with the care they are receiving; however, there remains a stagnancy to their condition and a need for more supports, whether that is provision of adaptive equipment, more continual follow-up visits, access to transportation, or social supports for caregivers. There is a need for more rehabilitation professionals in the local workforce, both in clinics and in partnership with Comunidad Connect to provide home-based care. Specifically, there is a need for a staff occupational therapist with Comunidad Connect in order to support more continual and occupation-based care for their patients.