The study used an exploratory, descriptive, qualitative design, using in-depth interviews to explore the perceptions and satisfaction of caregivers regarding rehabilitation services from selected rehabilitation centres in the Western Cape.

The target population and inclusion criteria for this study involved all caregivers who volunteered to accompany people with disabilities to selected rehabilitation centres in the Western Cape, South Africa. The rehabilitation centres were selected based on the fact that they were primary healthcare centres as well as the populations that they service. People with disabilities are consulted through a referral system or through self-referral to the rehabilitation centres and they do not pay for services as healthcare services should be accessible for all. The sample consisted of caregivers of 13 individuals, conveniently selected from those patients with physical disabilities who had received rehabilitation services at the identified centres. The persons receiving rehabilitation at the centres include those with conditions such as stroke, amputations, head injuries, spinal cord injuries and neuromuscular disorders leading to disability.

An interview guide that consisted of open-ended, non-directive questions was used to explore the caregivers’ perceptions of and satisfaction with the rehabilitation services that their family member was receiving. An initial open-ended question was used to explore the caregivers’ perceptions of the rehabilitation service. Probes were used to obtain in-depth descriptions of their perceptions and satisfaction with the services. To ensure trustworthiness (Lincoln & Guba 1985) in this study, the interview guide was developed after the researcher conducted a systematic review, which focused on barriers and facilitators to rehabilitation services (Mlenzana et al. 2013). Themes that emerged from the systematic review were: financial difficulties, caregiver and therapist relationship, facility management and caregiver experience with service delivery, and were used as predetermined themes of this study. The interview guide was developed and reviewed by individuals considered experts in the area of disability and rehabilitation. Participants who were recruited were fluent in English and Afrikaans.

Twenty-six suitable participants were telephoned and, following an explanation of the purpose of the study, were asked to participate. However, of these participants, only 13 were available for interviews and some indicated a willingness to participate but did not arrive on the particular day. An appointment to conduct the interviews was made with those who agreed telephonically to participate in the study. The researcher followed up on the participants who did not arrive, and they stated that they had other commitments on the day of the interview. Informed written consent was obtained from all participants before each interview was conducted. Participants were assured of anonymity and their right to withdraw from the study. In addition, permission to audio-record the interview was also obtained from the participants. Interviews were conducted during June 2011, using in-depth interviews, and were carried out in the caregivers’ homes or at the rehabilitation centres at a time that was suitable for them. The audio-recordings were transcribed verbatim. The participants were given an option as to the language in which the interviews could be conducted. Eight of the interviews were conducted in Afrikaans. The research assistant who was with the researcher was fluent in both English and Afrikaans. Interviews were conducted in both languages to accommodate the group and the interview guide was prepared in both English and Afrikaans.

All taped interviews were transcribed verbatim. The transcripts were then compared to the voice recordings to verify accuracy. The Afrikaans transcripts were translated into English after the recordings were verified. Transcriptions were translated from English and back to the interviewees’ language to ensure validity. Data were analysed using a coding process to sort the information according to categories within the predetermined themes. Data analysis was performed using the following predetermined themes: financial difficulties, caregiver and therapist relationship, facility management and caregiver experience with service delivery. Within the predetermined themes, categories were identified by the first author and consensus was reached through discussion with the second author. All categories were supported with quotes from the interviews.

Ethical clearance to conduct the study was obtained from the Senate Research Ethics Committee of the University of the Western Cape, reference number: 10/1/3.

The study sample consisted of 13 participants with a mean age of 47 years for the caregivers and 59 years for the patients. The majority of the caregivers were female and in most instances the spouse of the patient (Table 1).

The four main emerging themes and categories are presented in Table 2. Quotes to support the themes will be presented below.

The majority of caregivers interviewed voiced that they experienced financial difficulties. The most common financial challenge was the cost associated with transportation to the rehabilitation service. Six of the caregivers expressed that they frequently experienced difficulty with transportation when travelling to and from centres. The challenges included not having money to pay for transportation to the rehabilitation service:

A similar situation was highlighted in South Africa more than 10 years ago by Whitelaw et al. (1993), who reported that rehabilitation at a tertiary hospital in Cape Town was a challenge owing to poor attendance caused by transport problems. Likewise, De la Cornillere (2007) reported similar findings where transport was the major problem affecting attendance at rehabilitation sessions at one of the CHCs in Cape Town. This remained a challenge even more recently when Kahonde et al. (2010) reported similar challenges.

Categories identified within this theme included caregiver integration in the rehabilitation process, exchange of information between the therapist and the caregiver, and trust in the relationship between caregiver and therapist. The majority of caregivers expressed that they received education and were included in the rehabilitation process:

Contrary to previous studies (Kahonde et al. 2010), the participants in this study reported a good interaction with their therapists and indicated that they received the necessary information. A review conducted by Mlenzana et al. (2013) highlighted the importance of a positive caregiver-therapist relationship.

Caregivers highlighted that access to rehabilitation services was not a problem even with the patients’ use of assistive devices:

However, processes within the centres were a challenge and these included accessing files prior to therapy and obtaining appointments:

At least eight of the caregivers felt that the frequency of appointments was insufficient. Caregivers highlighted the long waiting periods between follow-up sessions:

The Primary Health Care approach refers to accessibility as one of the components that is important for service delivery. Authors Brereton and Nolan (2002) confirmed in their study that, during visits to the health centres, caregivers noticed that healthcare professionals were busy and, as a result, patients had to wait longer to receive care within the health centre. Caregivers in this study were dissatisfied with the management of patients at the rehabilitation centres and expressed irritation with service delivery as things were not to their level of satisfaction during the visit. It is clear that caregivers need better service delivery from these centres as they experienced the visits as time-consuming and disorganised. This shows that the problem of overcrowding at the rehabilitation centres causes dissatisfaction regarding the service provided.

During the interview process, it became evident that the quality of care a caregiver is able to provide is influenced by support for his or her own physical and emotional health. The caregivers highlighted that they were not always physically capable of actively assisting the patient, and support from others was welcomed:

In addition, it was evident that caregivers often neglected their own emotional needs. Caring for another person seems to have an impact on the caregivers’ stress levels:

The findings reported by the carers regarding their physical and emotional health are similar to other studies (McLaughlin et al. 2010; Shewchuk et al. 2004) that highlighted how the impact of living and caring for people with disabilities, whether physical or mental, affects various aspects of the caregivers’ lives. Thus, although the perceptions of the caregivers regarding rehabilitation services were primarily positive, it is evident that there is a need for consideration to be given to incorporate the carer in the process of rehabilitation with a focus on ways to decrease the burden of caring. Shewchuk et al. (2004) highlighted the need for rehabilitation interventions that focus on helping caregivers develop skills and strategies to address patient-centred emotional issues.