The impact of a community based rehabilitation program in Afghanistan: a longitudinal analysis using propensity score matching and difference in difference analysis
Abstract Background The 2006 United Nations Convention on the Rights of Persons with Disabilities states that the achievement of equal rights, empowerment and social inclusion of people with disabilities requires comprehensive rehabilitation services encompassing all components of the World Health O...
Main Authors: | , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2021-08-01
|
Series: | Conflict and Health |
Subjects: | |
Online Access: | https://doi.org/10.1186/s13031-021-00397-y |
id |
doaj-801b1b7c45a544f39dd2456d4a17e473 |
---|---|
record_format |
Article |
spelling |
doaj-801b1b7c45a544f39dd2456d4a17e4732021-08-22T11:13:11ZengBMCConflict and Health1752-15052021-08-0115112110.1186/s13031-021-00397-yThe impact of a community based rehabilitation program in Afghanistan: a longitudinal analysis using propensity score matching and difference in difference analysisJean-Francois Trani0Juanita Vasquez-Escallon1Parul Bakhshi2Institute of Public Health, Brown School, Washington University in St Louis2UNICEFInstitute of Public Health, Program in Occupational Therapy, Washington University School of MedicineAbstract Background The 2006 United Nations Convention on the Rights of Persons with Disabilities states that the achievement of equal rights, empowerment and social inclusion of people with disabilities requires comprehensive rehabilitation services encompassing all components of the World Health Organization Community based rehabilitation (CBR) matrix: health, education, livelihood, social and empowerment. CBR programs specifically aim to deliver such comprehensive interventions. In the present study, we investigate the impact of a CBR program in Afghanistan on all these components. Methods We enrolled 1861 newly recruited CBR participants with disabilities in the study, from 169 villages between July 2012 and December 2013 as well as 1132 controls with disabilities randomly selected through a two-stage process within 6000 households from 100 villages in the same provinces but outside the catchment area of the CBR program. We interviewed them again after one (midline) and two (end-line) years in the study. Using propensity score matching and difference in difference analysis, we estimated the impact of the CBR on outcomes of interest, namely mobility, activities of daily living, communication, participation in social and community life, emotional well-being and employment. Results Three years on average into the CBR program, participants showed a significant and close to medium effect size reduction in emotional (Cohen’s d = − 0.48, 95%CI[− 0.58--0.38]), and social participation challenges (Cohen’s d = − 0.45, 95%CI[− 0.53−− 0.36]); small to medium effect size reduction in unemployment (Cohen’s d = − 0.21, 95%CI[− 0.33--0.10]), activities of daily living (Cohen’s d = − 0.26, 95%CI[− 0.35--0.18]), mobility (Cohen’s d = − 0.36, 95%CI[− 0.44--.29]) and communication challenges (Cohen’s d = − 0.38, 95%CI[− 0.46--0.3]). Conclusions Our study indicates that a CBR program may provide positive rehabilitation outcomes for persons with disabilities even in a conflict context, and improve overall well-being of all participants with disabilities, whatever their impairment, individual characteristics and the CBR matrix components considered. Trial registration ISRCTN, ISRCTN50214054 . Registered August 5th 2020 - retrospectively registeredhttps://doi.org/10.1186/s13031-021-00397-yAfghanistanCommunity based rehabilitationDifference in differenceDisabilityImpact evaluationLow middle income countries, propensity score matching |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jean-Francois Trani Juanita Vasquez-Escallon Parul Bakhshi |
spellingShingle |
Jean-Francois Trani Juanita Vasquez-Escallon Parul Bakhshi The impact of a community based rehabilitation program in Afghanistan: a longitudinal analysis using propensity score matching and difference in difference analysis Conflict and Health Afghanistan Community based rehabilitation Difference in difference Disability Impact evaluation Low middle income countries, propensity score matching |
author_facet |
Jean-Francois Trani Juanita Vasquez-Escallon Parul Bakhshi |
author_sort |
Jean-Francois Trani |
title |
The impact of a community based rehabilitation program in Afghanistan: a longitudinal analysis using propensity score matching and difference in difference analysis |
title_short |
The impact of a community based rehabilitation program in Afghanistan: a longitudinal analysis using propensity score matching and difference in difference analysis |
title_full |
The impact of a community based rehabilitation program in Afghanistan: a longitudinal analysis using propensity score matching and difference in difference analysis |
title_fullStr |
The impact of a community based rehabilitation program in Afghanistan: a longitudinal analysis using propensity score matching and difference in difference analysis |
title_full_unstemmed |
The impact of a community based rehabilitation program in Afghanistan: a longitudinal analysis using propensity score matching and difference in difference analysis |
title_sort |
impact of a community based rehabilitation program in afghanistan: a longitudinal analysis using propensity score matching and difference in difference analysis |
publisher |
BMC |
series |
Conflict and Health |
issn |
1752-1505 |
publishDate |
2021-08-01 |
description |
Abstract Background The 2006 United Nations Convention on the Rights of Persons with Disabilities states that the achievement of equal rights, empowerment and social inclusion of people with disabilities requires comprehensive rehabilitation services encompassing all components of the World Health Organization Community based rehabilitation (CBR) matrix: health, education, livelihood, social and empowerment. CBR programs specifically aim to deliver such comprehensive interventions. In the present study, we investigate the impact of a CBR program in Afghanistan on all these components. Methods We enrolled 1861 newly recruited CBR participants with disabilities in the study, from 169 villages between July 2012 and December 2013 as well as 1132 controls with disabilities randomly selected through a two-stage process within 6000 households from 100 villages in the same provinces but outside the catchment area of the CBR program. We interviewed them again after one (midline) and two (end-line) years in the study. Using propensity score matching and difference in difference analysis, we estimated the impact of the CBR on outcomes of interest, namely mobility, activities of daily living, communication, participation in social and community life, emotional well-being and employment. Results Three years on average into the CBR program, participants showed a significant and close to medium effect size reduction in emotional (Cohen’s d = − 0.48, 95%CI[− 0.58--0.38]), and social participation challenges (Cohen’s d = − 0.45, 95%CI[− 0.53−− 0.36]); small to medium effect size reduction in unemployment (Cohen’s d = − 0.21, 95%CI[− 0.33--0.10]), activities of daily living (Cohen’s d = − 0.26, 95%CI[− 0.35--0.18]), mobility (Cohen’s d = − 0.36, 95%CI[− 0.44--.29]) and communication challenges (Cohen’s d = − 0.38, 95%CI[− 0.46--0.3]). Conclusions Our study indicates that a CBR program may provide positive rehabilitation outcomes for persons with disabilities even in a conflict context, and improve overall well-being of all participants with disabilities, whatever their impairment, individual characteristics and the CBR matrix components considered. Trial registration ISRCTN, ISRCTN50214054 . Registered August 5th 2020 - retrospectively registered |
topic |
Afghanistan Community based rehabilitation Difference in difference Disability Impact evaluation Low middle income countries, propensity score matching |
url |
https://doi.org/10.1186/s13031-021-00397-y |
work_keys_str_mv |
AT jeanfrancoistrani theimpactofacommunitybasedrehabilitationprograminafghanistanalongitudinalanalysisusingpropensityscorematchinganddifferenceindifferenceanalysis AT juanitavasquezescallon theimpactofacommunitybasedrehabilitationprograminafghanistanalongitudinalanalysisusingpropensityscorematchinganddifferenceindifferenceanalysis AT parulbakhshi theimpactofacommunitybasedrehabilitationprograminafghanistanalongitudinalanalysisusingpropensityscorematchinganddifferenceindifferenceanalysis AT jeanfrancoistrani impactofacommunitybasedrehabilitationprograminafghanistanalongitudinalanalysisusingpropensityscorematchinganddifferenceindifferenceanalysis AT juanitavasquezescallon impactofacommunitybasedrehabilitationprograminafghanistanalongitudinalanalysisusingpropensityscorematchinganddifferenceindifferenceanalysis AT parulbakhshi impactofacommunitybasedrehabilitationprograminafghanistanalongitudinalanalysisusingpropensityscorematchinganddifferenceindifferenceanalysis |
_version_ |
1721199973958156288 |