Study population, sampling and participants

3.4.1.

The study population consisted of persons (N=93) who suffered a SCI (traumatic or non-traumatic) and received rehabilitation at WCRC, or visited WCRC out-patient clinics between 31 March 2015 and 19 May 2015.

Inclusion criteria:

 Clients with complete and incomplete spinal-cord lesions who use manual wheelchairs as their primary means of mobility. Clients with incomplete spinal-cord lesions may have decreased sensation, mobility or continence that may put them at risk of developing a pressure ulcer.

 Clients with a SCI due to traumatic and non-traumatic causes  Clients older than 18

 Clients of all races  Clients of both genders

Exclusion criteria:

 Clients who were not primarily manual wheelchair users. The study was looking specifically at clients who used wheelchairs and some of the questions spesifically deal with behaviour in the wheelchair.

 Clients with cognitive impairments who could limit the ability of the client to consent, participate or remember information provided on pressure ulcers during rehabilitation. While acknowledging that this is an important sub-group of the population who are even more at risk of developing pressure ulcers (Raetz & Wick, 2015), preventative practices for this group may not be self-driven and the aim of this study was to, specifically describe the knowledge, practices and beliefs of clients with SCI.

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 Clients who could not self-propel their wheelchairs and/or used motorised wheelchairs. The reasoning behind excluding clients who were not able to self-propel their

wheelchairs was two-fold. In the study done by Taule, Bergfjord, Holsvik, Lunde, Stokke, Storlid, Sørheim and Rekand (2013), it was found that one of the factors that significantly increased seating pressure in clients with SCI, thus putting them at greater risk of developing pressure ulcers, was if the participant was using a manual wheelchair. It has also been found in a study conducted by Chiodo et al. (2007) that clients with paraplegia and who are able to self-propel their wheelchairs, are at greater risk of developing pressure ulcers.

In addition, persons who provided peer counselling to persons with SCI at WCRC in 2015 (N=8) were included in the study. Peer supporters were included as study participants, as it is important to determine whether their knowledge of pressure-ulcer prevention is sufficient and correct. The peer supporters often assist with the training of clients and are also often asked questions regarding pressure care, by clients. The peer supporters that volunteer at the WCRC are former clients of the WCRC and are themselves wheelchair users.

3.4.2.

Consecutive sampling was used. According to Carter et al. (2011) this is when all the clients that meet the inclusion criteria over a certain period of time are invited to participate in a study. All clients who had been receiving rehabilitation as in-patients at WCRC, who were to be discharged during the study period and met the inclusion criteria, were invited to participate in the study. In addition, all clients with SCI who visited the out-patient clinic at WCRC during the study period, met the inclusion criteria and had been discharged for at least three months, were invited to participate in the study. This ensured results from clients who had just completed their rehabilitation as well as from clients who had been discharged for more than three months.

The Biostatistics Department of Stellenbosch University (SU) was contacted to ascertain the sample size needed for meaningful statistical analysis. Due to the study being descriptive in nature, the researcher was advised that a minimum of 30 participants were required, but that more participants would be preferable. In the studies on knowledge, attitudes, beliefs and practices referred to in the literature review, the number of participants ranged from 21 (King et al., 2008) to 148 (Guihan & Bombardiem, 2012). The researcher decided to try and recruit a minimum of 30 participants from the two client groups and all of the peer supporters (who numbered less than 30 in total).

With regard to the number of out-patients, the researcher studied the booking records of the out- patient department (OPD) at the WCRC and discussed it with doctors and nursing staff working in OPD. From this exercise she gathered that an average of twenty (20) clients with spinal-cord

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injuries had an OPD appointment every Tuesday, with another fifteen (15) to twenty (20) having appointments throughout the rest of the week. It was estimated that about half of these clients would adhere to the inclusion criteria as about half of the clients visiting the OPD are either not wheelchair users or used motorised wheelchairs. Clients are booked for follow-up appointments every six weeks if needed. Thus, after six weeks excessive duplication might occur and fewer participants eligible for the study might visit OPD. The researcher concluded that within a six-week period, on average, 90 out-patients might meet the inclusion criteria.

From the in-patient data it was found that on average three to four clients adhering to the inclusion criteria were being discharged from the centre weekly. It was thus estimated that in a six-week period 18 – 24 clients might possibly adhere to the study-inclusion criteria.

3.4.3.

The number of clients included in the study was as follows:  Out-patients: 33

 In-patients: 30  Peer supporters: 8

Table 3.1 provides additional information on the numbers of study participants. Table 3.1 Study Participants

Number of participants identified Number of participants refusing/unable to take part Number of inappropriate participants * Number of participants included in study In-patients 42 5 7 30 Out-patients 43 10 0 33 Peer supporters 8 0 0 8 Total 93 15 7 71

* During the time of data collection, there were seven clients admitted to the WCRC who were awaiting surgery. These clients had all undergone rehabilitation on a previous occasion and were thus being re-admitted for the sole purpose of the surgeries. It was decided not to include these clients in the study as they had not recently finished their rehabilitation process as in the case of the other in-patients and this might subsequently influence their knowledge and beliefs.

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