Understanding the Rehabilitation Needs of Displaced Persons - Evaluation Report

Summary

From September 05 to October 30, 2022, Learning, Acting, and Building for Rehabilitation in Health Systems (ReLAB-HS), led by Physiopedia, successfully delivered a Massive Open Online Course (MOOC) entitled “Understanding the Rehabilitation Needs of Displaced Persons” via the Physiopedia Plus (Plus) online learning platform. The program consisted of seven independent courses, which included:

1. Global Context for Displaced Persons
2. Health and Well-Being for Displaced Persons
3. Communication and Trauma-Informed Care for Displaced Persons
4. Considerations for Working with Diverse Displaced Person Populations
5. Considerations and Practical Tools for Working with Survivors of Sexual Violence and Trafficking
6. Considerations for Working with Survivors of Torture
7. Assessment and Management of Pain for Displaced Persons

In each course, the learner completed required learning activities and a final quiz that tested knowledge gained from the course. To complete the overall program, the learner had the option to submit and pass a written assignment.

The program was also supported with two optional live online webinars to provide opportunity for increased learner interaction and engagement with the content experts. The webinar recordings were made available on the Plus platform for participants unable to access the webinars live.

1. Trauma Informed Care and Working with Survivors of Torture Webinar with Eric Weerts, Rehabilitation Specialist Humanity and Inclusion and Sue Piché, Psychiatric and Mental Health Nurse
2. Pain Assessment and Management for Displaced Persons Webinar with Zafer Altunbezel, Physiotherapist and Naomi O’Reilly, Physiotherapist

Course Type: Free, Open, Online

Institution: ReLAB-HS via Physiopedia About this Course: This MOOC aimed to equip health and social care professionals with a comprehensive knowledge of the rehabilitation needs for displaced persons, so they can play an effective and proactive role in local and global efforts to increase access to high-quality rehabilitation.

Target Audience: These courses were designed and written for health and social care professionals, clinicians, students, assistants, and other rehabilitation-related health systems stakeholders.

Time Commitment: 22 hours over eight weeks (with an optional extra eight hours)

Date: September 5 to October 30, 2022, with live online webinars on the 6th October 2022 (Webinar 1 Trauma Informed Care and Working with Survivors of Torture Webinar) and on the 12th October 2022 (Webinar 2 Pain Assessment and Management for Displaced Persons). Remains available on Plus platform to members.

Requirements: Participants were required to complete online learning activities, participate in discussion forums, engage with additional resources, and complete course evaluations and quizzes.

Assessment: There was a quiz at the end of each course, and participants could complete an optional written assignment to demonstrate knowledge gained from the overall program of seven courses.

Awards: Seven course completion certificates awarding a total of 22.7 Plus (P+) points with an additional four Plus (P+) points available for the optional assignment to complete the program..

Accreditation: Each individual course was accredited for continuing education and professional development (CE/CPD) in Australia, South African and the USA and is formally accepted without accreditation as a professional development activity by many other countries

Registrations MOOC: 12,604

Registrations Live Webinars: 1,150

Countries Represented MOOC: 107

Countries Represented Live Webinars: 86

Professions Represented MOOC:  24        

Professions Represented Live Webinars: 10

Acknowledgments

The Understanding the Rehabilitation Needs of Displaced Persons MOOC was developed and delivered by ReLAB-HS and Physiopedia. The delivery of this MOOC was a highly collaborative effort made possible by valuable contributions from various parties. The United States Agency for International Development (USAID) funded Learning, Acting, and Building for Rehabilitation in Health Systems (ReLAB-HS) activity would like to thank the following people for their contributions to this work:

Course Coordinators: Rachael Lowe, Naomi O’Reilly.

Content Contributors: Rachael Lowe, Naomi O’Reilly, Nimisha Gorasia, Ayman Baroudi, Chidera Lilian, Vidya Acharya, Oyemi Sillo, Shaimaa Eldib, Thalia Zamora Gómez, Donald John Auson, Jordan Awale, Adiyta Vats, Laura Ritchie, Anna Fuhrman, Eric Weerts, Sue Piché, Zafer Altenbuzel, lona Fricker, Kamal Khalifa, Wala’a Awwad, Laura Gueron, Stanley Malonza, Jeniffer Chepkemoi, Jepkemoi Kibet, Patrick Le Folcalvez, Graziella Lippolis, Pasala Maneewong, Jenny Malmsten, Mia Sandor, Patricia Rocca, Courtland Robinson,  Rachael Tribe.

Webinar Content Experts: Eric Weerts, Sue Piché,  Zafer Altenbuzel, Naomi O’Reilly.

Course Facilitators: Naomi O’Reilly, Tarina van der Stockt, Lucy Aird, Jess Bell, Carin Hunter.

Webinar Facilitators: Amanda Ager, Naomi O’Reilly, Lucy Aird.

This publication is made possible by the support of the American people through the United States Agency for International Development (USAID) through the Learning Acting Building for Rehabilitation in Health Systems (ReLAB-HS) project. The contents are the sole responsibility of Physiopedia and ReLAB-HS and do not necessarily reflect the views of USAID or the United States Government.

For information regarding this report, please contact: Rachael Lowe ([email protected])

Introduction

People have always been on the move for many reasons, including war and conflict, insecurity, disasters, poverty, and to find work and seek a better life for themselves and their families. But more people are now on the move than ever before in our history, with migration increasing every year over the last two decades, particularly forced migration. In 2021, 89.3 million people were forced to flee their homes due to conflict, violence, fear of persecution and human rights violations. This is more than double the 42.7 million people who were forcibly displaced a decade ago, and the highest it has been since World War II. Current evidence suggests that this number will continue to rise, with over 100 million people estimated to be displaced in 2022.

The need for rehabilitation services to meet the needs of displaced persons at each stage of the migration process is an urgent and growing global issue. The impact of forced migration on health and well-being is contributing to rapid global increases in the numbers of people experiencing a decline in functioning, resulting in enormous unmet rehabilitation needs. Much of these unmet needs are concentrated amongst the poorest and most vulnerable populations. Low- and middle-income countries host 83% of all displaced persons, with 27% hosted in the least developed countries, including Bangladesh, Chad, the Democratic Republic of the Congo, Ethiopia, Rwanda, South Sudan, Sudan, Uganda, the United Republic of Tanzania, and Yemen. These countries are often ill-equipped to cope with the increasing need for rehabilitation services.

The role of the health and social care professional is key in the rehabilitation process for displaced persons and this series of courses provides a comprehensive perspective on the effects of displacement on health and well-being.

During September and October 2022, ReLAB-HS, led by Physiopedia, delivered a Massive Open Online Course (MOOC) entitled, “Understanding the Rehabilitation Needs of Displaced Persons.”  The MOOC was delivered as seven individual courses with an optional written final assignment to complete the full program of courses.

The Understanding the Rehabilitation Needs of Displaced Persons program aimed to equip rehabilitation professionals with a comprehensive knowledge of rehabilitation for displaced persons so that they can play an effective part in the interdisciplinary management of displaced persons through all stages of the migration process. It also aims to enable rehabilitation professionals to play a proactive role in global and local efforts to increase access to high-quality rehabilitation for displaced persons through all stages of the migration process.

The eight week-long program presented different topics exploring the needs of displaced persons through a variety of learning activities to suit all learning styles. The required learning activities within each course were developed to take between two to four hours depending on the participant's learning style, with optional activities provided should the participant wish to take part in additional learning. A short orientation period before the course provided participants with an opportunity to become familiar with the delivery platform and the topics via the provided pre-course resources.

The course was delivered through the Plus online learning platform, an innovative platform specifically developed to provide online education and support participants with a personalized learning dashboard. For each course, the related learning activities were outlined on a specific course page. Participants engaged with each course and the respective learning activities, and their activity was recorded and displayed in their personal learning dashboard.

A course was considered complete once the learner finished all required learning activities and successfully passed the final quiz that tested the knowledge gained within each individual course of the program. On completion of each course the participants had the option to download a completion certificate and export a record of their learning from their activity log. There was also an optional written assignment designed for participants to apply the knowledge gained from the overall program consisting of  seven courses.

This report evaluates the engagement and experiences of the participants on the Understanding the Rehabilitation Needs of Displaced Persons MOOC.

1.0 About the Program of Courses

1.1 Aim

Through this MOOC, ReLAB-HS aimed to build on recent work to strengthen the advocacy case for better access to rehabilitation for displaced persons by increasing knowledge among global stakeholders and build on Physiopedia’s global community of professional participants to amplify the growing voice of rehabilitation professionals advocating for access to rehabilitation.

In order to achieve this, a program of seven courses was created with the aim of developing a comprehensive program to equip rehabilitation professionals with a far reaching knowledge of rehabilitation for displaced persons to enable them to play a proactive role in global and local interdisciplinary efforts  to increase access to high-quality rehabilitation for displaced persons through all stages of the migration process.  

1.2 Learning Objectives

At the end of this program of courses, participants were able to:

1. identify the different types of displaced persons
2. describe the global context surrounding the migration of displaced persons
3. explain the impact of media portrayal on attitudes towards displaced persons
4. explore country-specific knowledge about policy and legislation in the migration field to enhance understanding of the life situation of displaced persons
5. describe the impact of migration on health
6. identify health, functioning and disability stemming from the migration process
7. explain the common challenges refugees face in receiving optimal health care
8. identify three barriers to accessing health care for displaced persons
9. discuss the role of the Salutogenic approach to health and well-being for displaced persons
10. describe self-care strategies to keep yourself safe and well when working with displaced persons
11. discuss how to cultivate cultural sensitivity in order to create a trusting therapeutic space and facilitate communication with patients and significant others
12. explain the role that translators and interpreters play in facilitating optimal communication when working with displaced persons
13. identify holistic approaches that reduce the impact of trauma and address patient difficulties related to trauma and psychosocial issues
14. describe strategies to reduce barriers to interprofessional communication and facilitate effective interprofessional teamwork
15. discuss the role of a rehabilitation professionals in a camp setting
16. describe the impact of forced migration on children and adolescents
17. explain the impact of forced migration on older persons
18. describe the impact of forced migration on members of the LGBTQIA+ community
19. discuss strategies to minimise barriers to culturally competent care for LGBTQIA+ displaced persons
20. explain the prevalence of sexual violence
21. describe the consequences of sexual violence and female genital mutilation
22. discuss why sexual violence occurs in conflict settings
23. explore practical strategies to calm the response of the nervous and limbic systems in displaced persons who have experienced sexual violence
24. explain what torture is and its impact on survivors
25. choose two appropriate treatment options for working with a survivor of trauma
26. describe techniques for building trust and creating a safe therapeutic relationship with survivors of torture
27. summarise the multidimensional nature of pain, its implications for displaced persons, and relationship to clinical interventions
28. describe the five main domains of the Pain and Disability Drivers Model (PDDM) that may be contributing to pain and disability
29. describe pain management strategies

1.3 Intended Audience

This course is suitable for all rehabilitation professionals, students, and assistants, including but not limited to: physiotherapists, occupational therapists, speech and language therapists, rehabilitation doctors, rehabilitation nurses, prosthetists, orthotists, psychologists, audiologists, dietetics, social workers, and community-based health workers.

1.4 Cost to Participants

The course was free to all participants who completed the course within the 8-week timeframe and remains free to all Plus members and residents of low-income countries outside of this timeframe.

1.5 Course Availability

The program of seven courses with optional assignment was made available on September 5, 2022. Participants had until October 30, 2022 to complete the courses under their free access to Plus. The course remains available on the Plus platform to members; membership is free to individuals from low-income countries and available at a discounted rate to individuals in middle-income countries.

1.6 Courses, Course Awards, and Accreditation

Seven individual courses were created for the Understanding the Rehabilitation Needs of Displaced Persons program, which could each be completed individually or can be completed as a program of courses with an additional assignment. Plus provided individual course completion certificates to all participants that passed each of the individual courses or attended the webinars. For each course completion participants were also awarded continuing professional development (CPD) points. Individuals who completed all seven courses and completed the assignment were also provided with a program certificate for recognition of completing the full program.

Course 1: Global Context for Displaced Persons (3.9 CPD points)

Course 2: Health and Well-Being for Displaced Persons (3.9 CPD points)

Course 3: Communication and Trauma-Informed Care for Displaced Persons (4.4 CPD points)

Course 4: Considerations for Working with Diverse Displaced Person Populations  (4.0 CPD points)

Course 5: Considerations and Practical Tools for Working with Survivors of Sexual Violence and Trafficking (1.9 CPD points)

Course 6: Considerations for Working with Survivors of Torture (2.4 CPD points)

Course 7: Assessment and Management of Pain for Displaced Persons (2.2 CPD points)

Course Program: Understanding the Rehabilitation Needs of Displaced Persons (5.0 CPD points)

Webinar 1: Trauma Informed Care and Working with Survivors of Torture Webinar (0.8 CPD points)

Webinar 2: Pain Assessment and Management for Displaced Persons Webinar (1 CPD points)

2.0 Demographics of the Participants

2.1 Country

Of the 12,604 individuals registered for the MOOC from 167 countries, 868 individuals completed the Pre-Course Knowledge and Competency Self-Rating Tool from 94 countries, with 796 individuals from 88 countries starting Course 1 (Global Context for Displaced Persons) and 335 individuals from 58 countries starting Course 7 (Assessment and Management of Displaced Persons with Pain) before October 30, 2022. The Post-Course Knowledge and Competency Self-Rating Tool was completed by 127 individuals from 33 countries.

Table 1 and Figure 1 below show the numbers of participants and completion rates for participants for the  top ten represented countries across all seven courses. The  highest level of participation for each of these countries occurred in Course 1 (Global Context for Displaced Persons), which had the highest overall participation of all seven courses with 796 individuals. Of these ten countries the Netherlands had the highest completion rate overall at 88%, followed by the Ukraine with a completion rate of 66%.

A full list of all countries with the number of participants from each country and completion rates for each course can be found in Appendix 1.  

Table 1: Top Ten Represented Countries Participation and Completion Rates Data are numbers (n) that started Course 1 and the number (n1) and percentage (%) that completed the final Course 7 (Assessment and Management of Pain in Displaced Persons) (%

Country	n (number started)	n1 (number completed)	% (percentage completed)
Nigeria	78	15	19%
Pakistan	60	17	28%
Ukraine	59	39	66%
United States of America	55	16	29%
India	54	15	28%
United Kingdom	45	15	33%
Canada	31	6	20%
Australia	23	7	30%
Uganda	19	2	11%
Netherlands	16	14	88%

Table 2 below shows a breakdown of participation and completion data by country income classification, with the highest number of participants for all seven courses and the program coming from low to middle income countries. Highest completion rates for the individual courses were also predominantly seen among those from low (range 64% - 100%) and  low to middle income countries (range 50% - 94%) with 100% compilation seen for low income countries for Course 5 (Considerations and Practical Tools for Working with Survivors of Sexual Violence and Trafficking) and Course 6 (Considerations for Working with Survivors of Torture) highlighted in red below.

Table 2: Country Income Classification - Data are numbers (n) who started each course and percentage (%) of participants from country income classification who completed each course

Country Classification	Course 1 n (%)	Course 2 n (%)	Course 3 n (%)	Course 4 n (%)	Course 5 n (%)	Course 6 n (%)	Course 7 n (%)	Program n (%)
High	229 (50%)	115 (85%)	104 (88%)	76 (92%)	72 (93%)	74 (95%)	96 (78%)	48 (2%)
High-Middle	53 (36%)	19 (84%)	16 (88%)	12 (75%)	13 (69%)	12 (83%)	30 (67%)	10 (0%)
Low-Middle	333 (50%)	168 (89%)	111 (93%)	108 (91%)	106 (95%)	100 (94%)	145 (77%)	74 (4%)
Low	50 (64%)	34 (74%)	21 (95%)	21 (86%)	12 (100%)	14 (100%)	19 (79%)	12 (0%)

Finally Table 3 and Figure 2 highlight the participation and completion of participants from ReLAB-HS countries, with the highest number of participants for all seven courses and the program coming from the Ukraine. Highest completion rates for the individual courses were seen by those from Myanmar (range 25% - 100%), Ukraine (range 71% - 100%) and Uganda (range 68% - 100%) with 100% completion rates highlighted in red  below.

Table 3: ReLAB-HS Countries Participation and Completion Rates - Data are numbers (n) who started each course and percentage (%) of participants from ReLAB-HS countries who completed each course

ReLAB-HS Country	Course 1 n (%)	Course 2 n (%)	Course 3 n (%)	Course 4 n (%)	Course 5 n (%)	Course 6 n (%)	Course 7 n (%)	Program n (%)
Myanmar	4 (25%)	2 (100%)	2 (100%)	1 (100%)	3 (67%)	4 (100%)	4 (100%)	1 (0%)
Pakistan	60 (37%)	18 (78%)	16 (75%)	15 (80%)	17 (76%)	14 (93%)	22 (17%)	18 (6%)
Uganda	19 (68%)	42 (93%)	6 (100%)	5 (80%)	4 (100%)	4 (100%)	4 (100%)	1 (0%)
Ukraine	59 (71%)	12 (75%)	39 (95%)	41 (93%)	36 (100%)	40 (93%)	44 (89%)	16 (6%)

While overall completion rates for each of the individual courses were high, the completion rates seen for the program of Courses, which involved completion of an assignment are much lower (range 0% - 6%), suggesting minimal interest or motivation of participants to complete the optional assignment.

2.2 Professions

Twenty-four different professions started the Understanding the Rehabilitation Needs of Displaced Persons program before the end date of October 30, 2022. The top ten represented professions can be found in Table 4. Physiotherapist and Physical Therapist including DPT represented the greatest number of participants in all seven courses, followed by students (all professions combined) and Occupational Therapists. Completion rates varied, but it is evident from the data below that the profession with lower numbers of participants do appear to have higher completion rates overall, in many cases with 100% rates as highlighted in red below. A full list of participants' professional backgrounds can be found in Appendix 1.

Profession	Course 1 n (%)	Course 2 n (%)	Course 3 n (%)	Course 4 n (%)	Course 5 n (%)	Course 6 n (%)	Course 7 n (%)	Program n (%)
Physiotherapist /Physical Therapist including DPT	338 (49%)
Student (All Professions Combined)
Occupational Therapist
Nurse
Doctor of Medicine
Massage Therapist
Physical Rehabilitation Doctor
Physiotherapy Assistant / Physical Therapy Assistant
Psychologist
Speech and Language Therapist
Educator