REFLECTIONS OF AN INTERNATIONAL QUALITATIVE STUDY EXPLORING LOWER LIMB PROSTHESIS USE IN KENYA

K. Mattick1,2, B. Oldfrey3,4, J. Gakunga5, G. Magomere6, M. Donovan-Hall7, C. Holloway8,21University College London, Computer Science, London, United Kingdom, 2Global Disability Innovation Hub, London, United Kingdom, 3University College London, Institute of Making, London, United Kingdom, 4Global Disability Innovation, London, United Kingdom, 5Association of the Physically Disabled of Kenya, Mombasa, Kenya, 6Community Researcher, Nairobi, Kenya, 7University of Southampton, Environment and Life Sciences, Southampton, United Kingdom, 8University College London, UCLIC and Computer Science, London, United KingdomBackground: Low- and middle-income countries (LMICs) are projected to have a rapid increase in amputations in the coming years. People living with limb loss can encounter a process of loss and adjustment to a changed appearance, difference in functional ability and potential dependence on others.Prosthetic rehabilitation can offer hope and support for a person with limb loss. However, access to a device and a supporting service is limited in LMICs and research to inform prosthesis delivery is lacking.AT2030, a UK-aid funded programme is testing “What Works” in delivering Assistive Technology (AT) globally. Related to this wider aim, an MSc project conducted funded AT2030 research that aimed to understand prosthesis users’ experiences in Mombasa, Kenya.The COVID-19 pandemic travel restrictions disrupted initial plans and therefore the UK team, in collaboration with a Kenyan-based research team, conducted 10 interviews using Microsoft Teams with prosthesis users in Kenya.Purpose: The primary objective was to explore the experiences of lower limb prosthesis users in Mombasa, Kenya using qualitative semi-structured interviews.With interviews unexpectedly conducted over calls instead of in-person, this paper reflects on the process of telephone interviewing within low-resource settings.Methods: A qualitative approach to explore motivations and satisfaction of individuals with lower limb loss engaging with a prosthetic service in Mombasa. A Kenyan based orthopaedic technician supported in participant recruitment. In-depth interviews were conducted over Microsoft Teams with 10 lower limb prosthesis users, a Swahili translator, and UK based MSc student. Thematic analysis was applied.Results: Primary objectives: Five key themes emerged: acceptance, self-determination, hope, clinician relationship and perception. Findings demonstrate the importance of hopeful thinking and a supportive community in overcoming challenges. The findings highlighted the value of the rehabilitation relationship beyond prescription of a prosthesis.Secondary objectives: Co-researching with a Kenyan based team created effective participant recruitment and context specific insights. Telephone interviews enabled participants living rurally to participate. The environmental impact of the research was reduced without UK researchers travelling to Kenya. Conducting interviews in a different language, over telephone reduced UK researchers’ ability to influence direction of conversation. With no video, there was increased anonymity between interviewers and interviewees, which may have facilitated honest conversation.Conclusions: This research provides an understanding of lower-limb prosthesis users’ satisfaction of a device and motivation for engaging with a prosthetic service within a low resource setting. These results have relevance in developing patient-centred services, assistive devices and personnel training that are responsive to the needs of the service user. This is of interest as AT services are newly developed in low resource settings.There is opportunity to further explore the use of telephone interviews to conduct qualitative research across countries, cultures, and languages.Implications: Rehabilitation professionals should consider how to foster a supportive network amongst service users and how hopeful thinking can be facilitated during rehabilitation. Service users should be consulted on what is deemed a successful outcome.Co-research and collaborative methods can facilitate international research. Flexible and adaptable methods of data collection can increase the evidence base and understanding within prosthetic rehabilitation in low-resource settings.Funding acknowledgements: Foreign, Commonwealth and Development Office (FCDO, formerly Department for International Development (DFID)), grant number GB-GOV-1-300815 Award date: 28/01/2019.Keywords:Qualitative ResearchProstheticsCo-researchTopics:Disability & rehabilitationResearch methodology, knowledge translation & implementation scienceDid this work require ethics approval? YesInstitution: University College LondonCommittee: University College London Ethics CommitteeEthics number: APDKNAT/AmparoGmbH/001/05/2019All authors, affiliations and abstracts have been published as submitted.