Training needs on community-based rehabilitation of commune health workers in Viet Nam

Training needs on community-based rehabilitation of commune health workers in Viet Nam | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Training needs on community-based rehabilitation of commune health workers in Viet Nam Huong Thi Nguyen, Chi Linh Bui, Anh Mai Nguyen, Luong Thi Hien Nguyen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8267271/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Purpose To identify the training needs regarding Community-Based Rehabilitation (CBR) among commune health workers in Vietnam. Materials and methods A cross-sectional study was conducted in Nghe An province from 2021 to 2022. Quantitative data were collected from 114 health workers using structured interviews. Qualitative data were gathered through 16 in-depth interviews (IDI) and 8 focus group discussions (FGD). Results The majority of participants were female (70.2%). The primary fields of study were nursing and general medicine, with no participants specialized in rehabilitation. All participants (100%) expressed a need for training, particularly on the “Disability Model” (64.9%). Health workers preferred training in the form of group discussions, led by instructors from the provincial level or a university. The preferred training locations were district health centers or commune People's Committees. They desired a course duration of 1–3 days, held once a year. Conclusions It is essential to strengthen continuous, periodic training on CBR knowledge and practical skills for grassroots health workers. These training sessions should be organized as direct workshops at the district and commune levels, led by senior health officials, to better support people with disabilities and their caregivers. Training needs community-based rehabilitation commune health workers Vietnam Introduction According to the sample survey, by the end of 2016-early 2017, if adding data from the General administrative review, the total of people with disabilities in the entire country is 6,225,519 persons, in which 671,659 children aged 2–17 and 5,553,860 people aged 18 years and older. The results of the household survey show that 7.06% of the population aged 2 and over are disabled. Of the total number of people with disabilities, many persons have multiple disabilities. The highest number of people with is lower mobility (3,566,854 people). The result also shows that 1,219,233 people with self-care disability. There are significant differences between people with disabilities and without disabilities in using health services: medical examination (69.4% versus 51.1%), medical treatment (57.4% versus 36.5%) and function rehabilitation (2.3% versus 0.3%) [ 1 ]. The percentage of people with disabilities who need help for daily activities is 26.7%, while only 2.0% in the non-disabled category. The prevalence rate for rural area is almost 1.5 times higher than in urban areas. The region with the highest disability rates is the North Central and Central Coast (NCCC), the lowest are found in the South East (SE) and Central Highlands (CH) [ 1 ]. Community-Based Rehabilitation is the process of rehabilitation carried out in the community with the participation and joint coordination of people with disabilities, their families, local authorities, grassroots healthcare, and other relevant agencies, organizations, and individuals. Community-Based Rehabilitation has many advantages, is effective, and saves costs for society, people with disabilities, and their families, as well as saving healthcare resources. It is particularly suitable for developing countries [ 2 ], [ 3 ]. However, limited infrastructure and a significant shortage of Community-Based Rehabilitation personnel hinder the development of rehabilitation activities for people with disabilities. The current situation regarding the distribution of people with disabilities and rehabilitation staff in Vietnam is extremely unreasonable. In areas where the rate of people with disabilities accounts for 75–80% (commune level), there are no rehabilitation staff. Meanwhile, in areas where only 1–5% of people with disabilities need rehabilitation, the proportion of rehabilitation staff is about 79–85% [ 2 ], [ 4 ], [ 5 ]. Thus, Community-Based Rehabilitation is the most effective solution to address the issues of people with disabilities, and the human resources to implement the technical aspects of the program must be specifically assigned. This is a decisive factor for the program's success. In 2016, in the whole country Việt Nam, 57.3% of Commune Health Centre (CHC) have rehabilitation programs, 90.6% of CHCs conduct education and disseminate knowledge about health care for people with disabilities and 88.3% of CHCs have logbook for disability tracking. There are many disparities among regions in implementing the rehabilitation programs, percentage of CHCs having the programs is lowest in NMM (39.3%) and highest in SE region (76%). Only 16.9% of CHCs are designed in line with accessibility standards for people with disabilities. Of which, NMM has only 7.8% of CHCs designed for people with disabilities, this proportion is 27.4% and 26.0% respectively in SE and the MRD [ 1 ]. The commune health station acts as the project management board at the commune level, implementing activities. Commune health workers collect data, monitor, and manage the program with the professional support of district and provincial rehabilitation technicians. The activities of commune health workers in the community-based rehabilitation program include 8 tasks: Processing and synthesizing survey results according to the "Disability Model" form, Assigning areas of responsibility for rehabilitation to community-based rehabilitation workers, Providing assessment forms for the rehabilitation outcomes of people with disabilities in the community to community-based rehabilitation workers, Monitoring the recording of rehabilitation outcomes by community-based rehabilitation workers on the assessment forms, Preparing content and organizing monthly rehabilitation handovers with community-based rehabilitation workers, Maintaining all records related to people with disabilities in the locality, Reporting difficulties faced by people with disabilities and their families during the rehabilitation process to the People's Committee and relevant departments, sectors, and levels of authority for necessary support, and Contacting higher levels for patient referrals or professional support when needed [ 6 ]. In reality, most communes mainly have lists and management records of people with disabilities, and keep minutes of regular handover meetings between the commune health station and collaborators. Additionally, the health station also has referral records for transferring people with disabilities to higher levels. [ 7 ] "Community-based rehabilitation (CBR) staff at health stations are still weak, while community-based rehabilitation heavily relies on these stations. The main activities at commune health stations and village health posts are advocacy and communication about community-based rehabilitation, alongside record-keeping and regular screening examinations for people with disabilities as mentioned above. At the commune level, the workload is high while human resources are limited, so advocacy activities are carried out more frequently [ 7 ]. The minimum training requirements for community-based rehabilitation workers should integrate aspects of disability identification, referral techniques, record-keeping, case management, as well as mobilization techniques and knowledge transfer to the community. Community workers need to be trained in basic counseling techniques and mental health referral mechanisms. Community rehabilitation workers must have knowledge of the Community-Based Rehabilitation Matrix, as well as social protection and potential contextual challenges in their area [ 8 ]. Meeting the rehabilitation and inclusion needs of people with disabilities in low- and middle-income countries requires adequately trained local staff. Currently, a lack of knowledge and understanding of the necessary competencies of community-based rehabilitation workers is affecting the quality of training and the workforce [ 9 ]. The quality of community-based rehabilitation (CBR) personnel is a key factor contributing to the success of community-based rehabilitation programs [ 10 ]. However, the current state of training in community-based rehabilitation is not widespread or standardized, and the methods of carrying out tasks and activities within those tasks are inconsistent. Currently, there are some studies on the knowledge, attitudes, and practices, and task performance of community-based rehabilitation workers, community-based rehabilitation collaborators, community-based rehabilitation program secretaries, and community-based rehabilitation programs. However, we have found very few studies on the community-based rehabilitation training needs of health staff in charge of the community-based rehabilitation program at the station. For these reasons, the research team wants to understand the training needs of commune health station staff in Thanh Chuong district, Nghe An province, to contribute to proposing solutions to strengthen community-based rehabilitation activities of health stations and improve the capacity of health station staff in charge of the community-based rehabilitation program. Results The study was conducted on 114 subjects selected via quantitative sampling and 24 individuals selected via purposive sampling (qualitative), who were health officials at the commune level from commune health stations, commune people's committees, district health officials, labor department officials, and village health workers in Thanh Chuong district, Nghe An province, in 2021–2022. The results are presented as follows: general information about the study subjects and their training needs regarding the eight tasks in the community-based rehabilitation program. Characteristics of the study subjects Of the 114 study subjects, 80 were female, accounting for 70.2%. The age group with the highest percentage was 30–49 years old, making up about half of the study subjects. The average age of the subjects was 40.36 ± 7.994 years. The educational level of the study subjects was highest for college graduates, at 50.0%. The main majors of the study subjects were nursing and general medicine, accounting for 28.9% and 14%, respectively, with no one having a rehabilitation major among the subjects (Table 3.1). Current status and format of training on CBR tasks for health workers The lack of training on all eight CBR tasks for health officials was quite high, over 89%. The highest percentage was for the task "Processing and synthesizing survey results according to the 'Disability Model' form," at 95.6%. Among the health officials who had been trained on CBR tasks, the primary training format was a workshop (Table 2 ). The qualitative interview results were consistent with the quantitative results. The eight CBR tasks for commune health officials were rarely performed. The task of "Storing all records related to people with disabilities and contacting the upper level to transfer patients or for professional support when needed" was performed more frequently than the others, as shared by a head of a health station: Rehabilitation projects and activities in the locality are almost non-existent, and home-based rehabilitation guidance has also been almost entirely unfulfilled (IDI 5, Commune Health Official). There is a need for a rehabilitation training program to be implemented synchronously at the local level. Synchronization in training and program implementation will help make the implementation and supervision processes more effective. As a health official shared: The effectiveness of the activities is not high because health workers and village health collaborators have not been adequately trained to be truly confident in performing and guiding community-based rehabilitation (IDI2, Commune Health Official). The low effectiveness of community-based guidance programs may also be due to the limited awareness of caregivers for people with disabilities and victims of Dioxin exposure, as a health official shared, " the family cannot do the things I guide them to do." In reality, commune and village health officials and collaborators are rarely trained. Periodic training on care and rehabilitation for the grassroots level is generally very limited, and training primarily happens when sponsored by a project. As shared by many health officials at the commune health stations who participated in the study, some commune health officials have been trained in rehabilitation once or twice. Their knowledge is mainly from "self-study," "doing it themselves." The study results show the necessity of increasing training for grassroots health officials on care and rehabilitation for people with disabilities and/or victims of Dioxin exposure. A district health official in charge of rehabilitation shared that they themselves have not received much training in rehabilitation. Yes, because the team also wants to participate and organize training to provide guidance to the grassroots level, so we know how to implement things when the grassroots level has guidance/ Secondly, since implementation started, it's been pretty much self-study, self-exploration, and just doing it on our own, without any training (IDI 5, Commune Health Official). The in-depth interviews also show the need for continuous training for collaborators so they can competently guide caregivers of people with disabilities and victims of Dioxin exposure. To do this, funding is needed for workshops as well as stipends for collaborators to perform the task of guiding patients' families in the community. Counseling is good, but specific guidance is needed. The important thing is what the collaborators should do? If they get trained but then do nothing, it's useless. And how do we guide them now? The guidance must require them to guide a certain number of people a certain number of times each month; we have that function and responsibility. But they need a policy for them because there are times when they are busy with other things (IDI 1, District Health Official). The qualitative interview results show the necessity of a rehabilitation training program to be implemented synchronously at the local level. In particular, for commune health officials to perform their assigned functions in community-based rehabilitation, continuous, skills-based training with supervision is needed. As shared in interviews with district and commune health officials, synchronization in training and program implementation will help make the implementation and supervision processes more effective: Preparing the content for the briefing meeting is naturally done, but there's no single unified standard yet. To know what content needs to be standardized, we need training. Records are stored, but how to store them to classify which ones need to be archived and which do not? Reporting difficulties during the process... this is related to the advisory work of the district health department (IDI1, District Health Official). When doing anything, we need synchronization, guidance, discussion, and record-keeping to be synchronized from top to bottom, so when we provide guidance, and health officials implement it, the inspection and supervision will also be effective (IDI2, Commune Health Official). The qualitative interview results show that direct workshop training is appropriate. Furthermore, those participating in the training need to be professionals with the ability to convey knowledge, but do not necessarily need to have high qualifications. It doesn't necessarily have to be someone with a high degree or anything, what's important is that they can convey the knowledge to the people being trained, what's important is that they understand (FGD1, Health Official). The selection of officials to participate in the workshops was also mentioned in the interviews. Some health officials believe that many officials should be sent to training in rotation and that enthusiastic officials who are committed to their work at the station should be chosen to maintain long-term guidance activities in the community. "First, it must be related to the officials; we must find people with professional knowledge who are enthusiastic about their work." If conditions are too difficult, we can organize one class at the district level, but if there's an abundance, we can organize it by bureau. For a district with 5 locations, it would certainly be of higher quality than training at a single location. Because if we organize it at one location and need many people, the station might send someone else who doesn't have rehabilitation expertise as a substitute, and the discussion won't be good because the person being trained might have an unexpected absence. If we organize it at multiple locations, the stations can send 2–3 people because it's nearby, so they can go, or if one can't go today, they can go to another training location tomorrow, thus achieving higher effectiveness (IDI1, District Health Official). Training needs on CBR for commune health workers The study results show that 100% of commune health officials expressed a need for training on the eight tasks in the CBR program (Table 3 ). The qualitative interview results also show that commune health officials all desire rehabilitation training because they have had little to no training. This lack of knowledge about rehabilitation makes them unconfident in performing activities to support people in the community with rehabilitation. My station really wants even the station staff and village health workers to be able to provide guidance. You guys should guide them on rehabilitation. As a doctor myself, I can't give in-depth guidance because I'm a general practitioner (IDI 3, Health Official). Officials who are trained in rehabilitation do attend workshops, but first, they attend software workshops. As for rehabilitation skills workshops, I haven't attended any. I would really want to participate if there was a training class. You guys should open a skills class and train the station head so I can participate. But now with rehabilitation content, no one comes and no one has a policy to hold a refresher workshop. To be honest, that person's skills also belong to pedagogical skills—how they convey it and how people absorb it? If they can't absorb it, then it's a wash (FGD1, Health Official). Most home-based rehabilitation guidance activities under the community-based rehabilitation program have not been carried out. In terms of management, my station manages everything, all of it. All people with disabilities, including those with mental illness, those who receive benefits, I have a list from beginning to end. My station has a specific management list. But to talk about examinations, people only come for check-ups when they're sick; we don't proactively go to them. Do you understand what I mean? For example, in this one month, you should at least go to one village and select 10 people to guide. That's what the training says, but I haven't been able to do it. I'll be frank, I haven't been able to do it, and the reality is that most communes haven't been able to either (IDI 4, Commune Health Official). Some commune health officials who participated in the interviews expressed a desire for the commune health official in charge of rehabilitation to be trained regularly to be able to carry out rehabilitation activities in the commune, such as using software and supporting people with disabilities, especially now that the COVID pandemic is not as severe as before. Commune health officials also believe that village health workers need to be trained in rehabilitation and care for people with disabilities so they can directly support patients in the community. Actually, going and knocking on each door to guide them, like we said, to guide them monthly, hasn't been done. They're locals there; the village health workers are directly there, so they can provide the guidance (IDI 4, Health Official). However, in reality, some policy barriers for village health workers in Vietnam today make it difficult to recruit them to participate in rehabilitation activities. As a commune health official shared, funding for village health workers has been cut in recent years, which has greatly affected their participation. Most of them participate as volunteers. In terms of both the training program and skills, I want to say that my station hopes to train the team of village health workers and the station's nurses so they can work more practically and have a certain level of professional expertise. At the very least, the station should have one official who specializes in rehabilitation so they understand and can pass it on to their staff, like nurses and orderlies. To be honest with you, in the past, all the project programs had money, but village health workers only got 0.3. With a subsidy of 0.3, what can they do? It's only a few hundred [thousand dong]. According to the new regulations from the Ministry of Health, my commune, which is an especially difficult one, should get 0.5, but now they've cut all of it. Village health workers don't even have 0.3 multiplied, so they only get a few hundred, so they don't do it. Honestly, even if you try to motivate them, they won't do it. If they do, it's just to be supportive, so only the enthusiastic ones, what they call volunteers in other countries, are the right ones. So they should be put in the case of volunteers (IDI 6, Health Official). Therefore, some commune health officials proposed that financial support is needed for village health workers to participate in the community-based rehabilitation program. For example, if we have a proper compensation policy for them, and village health workers get a worthy compensation, they will do specialized work and no other jobs anymore. They will focus on their expertise, like in mountainous areas, they won't have to work on their farms to earn extra income but will focus on their professional work, so if rehabilitation is needed, they will go right to the location (FGD1, Health Official). Reasons for needing annual training/retraining The reasons for needing annual training/retraining were to consolidate professional knowledge, serve job needs, and update new knowledge and skills, with high percentages over 55% at 59.6%, 57%, and 55.3%, respectively (Table 4 ). Desired training content on commune health officials' tasks in community-based rehabilitation activities The desire for training on the eight community-based rehabilitation tasks for health officials was high, with the highest being "Processing and synthesizing survey results according to the 'Disability Model' form," at 64.9% (Table 5 ). Among the group of subjects who desired training, the percentage who wanted training on the community-based rehabilitation tasks through workshops was the highest, mostly over 80%, with tasks 1 and 7 having the highest percentages of subjects choosing them at 84.2% and 83.3%, respectively (Table 5 ). In the group of subjects who desired training, the subjects wanted to be trained using all four methods: presentations, group discussions, practice on trainees, and practice on people with disabilities. Meanwhile, the percentage of subjects who wanted to be trained on community-based rehabilitation tasks via group discussions was over 43% (Table 5 ). The qualitative results show that most health officials who participated in workshops want to continue participating in training programs because they want better knowledge and skills in care and rehabilitation. A short training duration of about 1–3 days is suitable, and this result is consistent with the quantitative result. I attended one morning and found it very useful in helping them take better care of patients. And they called me and asked if they should buy a large spoon, which I could help with, or a towel, which is more difficult to wash daily. Overall, I don't have many comments on the other content; it's all good. The time is also suitable. I only participated in one session, so I don't know much. In my opinion, training for caregivers for 1–2 days is suitable because people in rural areas have a lot of work and can't go. The location at the People's Committee is very good. The lecturers are very enthusiastic and explain things meticulously. I haven't participated much, so I don't have many additional comments (IDI 4, Commune Health Official). Desired trainers and training locations for community-based rehabilitation tasks for health officials Among the group of subjects who desired training, the percentage who wanted to be trained on the community-based rehabilitation tasks by provincial-level officials was 50% or more for all tasks, followed by lecturers from the Hanoi University of Public Health, which was 28.9% to 39.5%. In contrast, the percentage of subjects who wanted to be trained by lecturers from the Medical College was small, ranging from 3.5% to 7.9% (Table 6 ). In the group of subjects who desired training, the percentage who wanted the training location for the community-based rehabilitation tasks to be the People's Committee/District, Town, or City Health Center was over 52% for all tasks, followed by the People's Committee/Commune or Ward Health Station, which was 43% to 51.8%. In contrast, the percentage of subjects who wanted to be trained at the Provincial Rehabilitation Hospital on the community-based rehabilitation tasks was only a maximum of 28.1% (Table 6 ). The qualitative interview results show similar results regarding the desire for training on the content of the community-based rehabilitation program. The proposed locations were mostly the People's Committee, and lecturers who taught meticulously and in detail. As a commune health official shared: The location at the People's Committee is very good. The lecturers are very enthusiastic and explain things meticulously. I haven't participated much, so I don't have many additional comments (IDI4, Commune Health Official). Desired duration and frequency of training on community-based rehabilitation tasks for health officials The desired training duration for community-based rehabilitation tasks for health officials was mostly 1–3 days for all tasks, ranging from 56.1% to 73.7% (Table 7 ). Among the subjects with training needs, the desired frequency of continuous training per year for community-based rehabilitation tasks for health officials was highest for one time, followed by two times and three times (Table 7 ). The qualitative results show that most health officials who participated in workshops want to participate in training programs because they want better knowledge and skills in care and rehabilitation. A short training duration of about 1–3 days is suitable, and this result is consistent with the quantitative result. I attended one morning and found it very useful in helping them take better care of patients. And they called me and asked if they should buy a large spoon, which I could help with, or a towel, which is more difficult to wash daily. Overall, I don't have many comments on the other content; it's all good. The time is also suitable. I only participated in one session, so I don't know much. In my opinion, training for caregivers for 1–2 days is suitable because people in rural areas have a lot of work and can't go. The location at the People's Committee is very good. The lecturers are very enthusiastic and explain things meticulously. I haven't participated much, so I don't have many additional comments (IDI 4, Commune Health Official). 3. Tables Table 1 Characteristics the study subjects Characteristics n (%) Gender Male 34 (29.8) Female 80 (70.2) Age groups (years old) < 30 11 (9.6) 30–39 51 (44.8) 40–49 34 (29.8) 50–59 16 (14.0) ≥ 60 2 (1.8) Mean age (years old) (Min-Max) 40.36 ± 7.994 (26–60) Education levels Elementary level 1 (0.9) Middle school level 26 (22.8) High school 0 College 57 (50.0) University 29 (25.4) Postgraduate 0 Other (Secondary school) 1 (0.9) Major Rehabilitation 0 Traditional medicine 11 (9.6) General Medicine 16 (14) Physician 14 (12.3) Nurse 33 (28.9) Midwife 15 (13.2) Medical Technician 0 Pharmacist 15 (13.2) Demography 9 (7.9) Nutrition 0 Preventive Medicine 1 (0.9) Public Health 0 Other 0 Total 114 (100%) Table 2 Current status and format of training on CBR tasks for health workers Job Responsibilities of a Commune Health Worker Current status of training Training format Untrained n (%) Trained n (%) Workshop/ Conference n (%) Training course Standardized training Distance learning Website on CBR/Disabilities Process and compile survey results according to the "Disability Model" form. 109 (95.6) 5 (4.4) 1 (0.9) 4 (3.5) 0 0 0 Assign areas of responsibility for rehabilitation to community-based rehabilitation staff. 107 (93.9) 7 (6.1) 1 (0.9) 6 (5.3) 0 0 0 Provide evaluation forms for rehabilitation outcomes of people with disabilities in the community to community-based rehabilitation staff. 105 (92.1) 9 (7.9) 1 (0.9) 7 (6.1) 0 0 1 (0.9) Monitor the recording of rehabilitation outcomes by community-based rehabilitation staff on the evaluation forms. 102 (89.5) 12 (10.5) 1 (0.9) 4 (3.5) 0 0 0 Prepare content and organize monthly rehabilitation meetings with community-based rehabilitation staff. 103 (90.4) 11 (9.6) 1 (0.9) 6 (5.3) 0 0 0 Maintain all records related to people with disabilities in the locality. 102 (89.5) 12 (10.5) 1 (0.9) 7 (6.1) 0 0 1 (0.9) Report difficulties of people with disabilities and their families in the rehabilitation process to the People's Committee and relevant departments, branches, and authorities at all levels for necessary support. 102 (89.5) 12 (10.5) 1 (0.9) 4 (3.5) 0 0 0 Contact higher levels for patient transfer or professional support when needed. 104 (91.2) 10 (8.8) 0 9 (7.9) 1 (0.9) 0 0 Table 3 Training needs on CBR for commune health workers Training needs n % Need training 114 100 Do not need training 0 0 Tổng 114 100 Table 4 Reasons for needing annual training/retraining TT Reasons n % 1 To meet job requirements 65 57 2 To reinforce professional knowledge 68 59.6 3 To improve professional skills 53 46.5 4 To update new knowledge and skills 63 55.3 5 To improve professional level 59 51.8 6 Due to changes in disease/disability patterns 21 18.4 Table 5 Desired content, format, and method of training on the duties of commune health workers in community-based rehabilitation activities. Contents Desired format n (%) Desired training method n (%) Content of CBR tasks n (%) Workshop/ Conference Training course Standardized training Distance learning Website on CBR/Disabilities Presentations Group discussions Practicing on students Practicing on people with disabilities Process and compile survey results according to the "Disability Model" form. 74 (64.9) 16 (14) 95 (83.3) 11 (9.6) 8 (7.0) 9 (7.9) 44 (38.6) 49 (43) 36 (31.6) 47 (41.2) Assign areas of responsibility for rehabilitation to community-based rehabilitation staff. 49 (43) 19 (16.7) 91 (79.8) 11 (9.6) 10 (8.8) 9 (7.9) 37 (32.5) 55 (48.2) 35 (30.7) 44 (38.6) Provide evaluation forms for rehabilitation outcomes of people with disabilities in the community to community-based rehabilitation staff. 46 (40.4) 18 (15.8) 89 (78.1) 13 (11.4) 7 (6.1) 16 (14) 37 (32.5) 55 (48.2) 38 (33.3) 44 (38.6) Monitor the recording of rehabilitation outcomes by community-based rehabilitation staff on the evaluation forms. 32 (28.1) 16 (14) 93 (81.6) 11 (9.6) 7 (6.1) 11 (9.6) 43 (37.7) 57 (50) 30 (26.3) 42 (36.8) Prepare content and organize monthly rehabilitation meetings with community-based rehabilitation staff. 49 (43.0) 21 (18.4) 94 (82.5) 12 (10.5) 6 (5.3) 11 (9.6) 44 (38.6) 51 (44.7) 37 (32.5) 41 (36.0) Maintain all records related to people with disabilities in the locality. 39 (34.2) 20 (17.5) 93 (81.6) 11 (9.6) 8 (7) 11 (9.6) 41 (36.0) 53 (46.5) 37 (32.5) 42 (36.8) Report difficulties of people with disabilities and their families in the rehabilitation process to the People's Committee and relevant departments, branches, and authorities at all levels for necessary support. 17 (14.9) 23 (20.2) 96 (84.2) 9 (7.9) 6 (5.3) 10 (8.8) 39 (34.2) 51 (44.7) 37 (32.5) 43 (37.7) Contact higher levels for patient transfer or professional support when needed. 39 (34.2) 22 (19.3) 94 (82.5) 12 (10.5) 5 (4.4) 8 (7) 39 (34.2) 57 (50) 32 (28.1) 37 (32.5) Table 6 Desired officers and training locations for community-based rehabilitation duties for health workers. Content of CBR tasks Desired training officer n (%) Desired location n (%) Central-level officer Provincial-level officer District-level officer Lecturer from the Hanoi University of Public Health Lecturer from the College of Health Provincial Rehabilitation Hospital People's Committee/ District, Town, City Health Center People's Committee/ Commune, Ward Health Station Other Process and compile survey results according to the "Disability Model" form. 27 (23.7) 58 (50.9) 37 (32.5) 45 (39.5) 7 (6.1) 28 (24.6) 69 (60.5) 49 (43) 0 Assign areas of responsibility for rehabilitation to community-based rehabilitation staff. 23 (20.2) 64 (56.1) 31 (27.2) 45 (39.5) 9 (7.9) 30 (26.3) 60 (52.6) 56 (49.1) 0 Provide evaluation forms for rehabilitation outcomes of people with disabilities in the community to community-based rehabilitation staff. 27 (23.7) 59 (51.8) 38 (33.3) 40 (35.1) 9 (7.9) 34 (29.8) 62 (54.4) 53 (46.5) 0 Monitor the recording of rehabilitation outcomes by community-based rehabilitation staff on the evaluation forms. 25 (21.9) 63 (55.3) 34 (29.8) 40 (35.1) 8 (7.0) 29 (25.4) 63 (55.3) 56 (49.1) 0 Prepare content and organize monthly rehabilitation meetings with community-based rehabilitation staff. 25 (21.9) 63 (55.3) 32 (28.1) 42 (36.8) 9 (7.9) 28 (24.6) 66 (57.9) 54 (47.4) 0 Maintain all records related to people with disabilities in the locality. 24 (21.1) 64 (56.1) 33 (28.9) 39 (34.2) 7 (6.1) 29 (25.4) 63 (55.3) 59 (51.8) 0 Report difficulties of people with disabilities and their families in the rehabilitation process to the People's Committee and relevant departments, branches, and authorities at all levels for necessary support. 26 (22.8) 66 (57.9) 33 (28.9) 37 (32.5) 5 (4.4) 32 (28.1) 61 (53.5) 56 (49.1) 0 Contact higher levels for patient transfer or professional support when needed. 22 (19.3) 66 (57.9) 34 (29.8) 42 (36.8) 6 (5.3) 32 (28.1) 60 (52.6) 56 (49.1) 1 (0.9) Methods This cross-sectional study, conducted in Thanh Chuong District, Nghe An Province from December 2021 to June 2022, used a mixed-methods approach. For the quantitative component, a total sampling method was used, surveying 114 health staff from all communes, including the head of each health station and two staff members involved in the community-based rehabilitation (CBR) program. Subjects were required to be at least 18 years old and actively working at a commune health station. For the qualitative component, purposive sampling was used to select 24 key informants from various levels, including commune and district health staff, provincial health department staff, and local government officials, who were knowledgeable about CBR. Quantitative data were collected through direct interviews using a structured questionnaire that had been pilot-tested and revised. The questionnaire focused on the current status and training needs related to CBR. Data were analyzed using SPSS 22.0, with descriptive statistics applied to the research variables (training needs, content, methods, location, frequency, and duration). Qualitative data were collected through in-depth interviews and focus group discussions lasting 45–60 minutes, guided by a semi-structured interview guide. Thematic analysis was used to analyze this data. The study was approved by the Ethics Committee of the Hanoi University of Public Health (Decision No. 131/2022/YTCC-HD3). All participants provided informed consent and were assured of confidentiality and the right to withdraw. To ensure data accuracy, the research team directly supervised data collection and randomly rechecked 10% of the completed questionnaires. Discussions This is the first study to investigate the CBR training needs of commune health officials in Nghe An province, Vietnam. The findings show a high demand for CBR training to provide rehabilitation for more people with disabilities. However, the CBR training needs in this study do not include the CBR training needs of caregivers and people with disabilities themselves, or of village health workers, to enable self-rehabilitation for people with disabilities and their caregivers. General Information on Study Subjects Regarding the general characteristics of the study subjects, out of the 114 subjects, 70.2% were female. This result, being high at over 70%, is consistent with the findings of a 2016 study by Nguyen Duc Truong et al. on commune health station staff in Yen Son district, Tuyen Quang province [ 11 ]. The age group with the highest percentage was 30–49 years old, which accounted for about half of the study subjects. The average age of the subjects was 40.36 ± 7.994 years. This result is also consistent with the findings of Nguyen Duc Truong's study on the current state of task performance and continuous training needs of commune health station staff in Yen Son district, Tuyen Quang province. In Nguyen Duc Truong's study, the 31–50 age group also accounted for 58.78%, over 50% of the study subjects [ 11 ]. The subjects' highest educational level was a college degree, at 50.0%. The main majors of the subjects were nursing and general medicine, with percentages of 28.9% and 14%, respectively. No one in the study group had a rehabilitation major. This is consistent with the current situation of an extremely unreasonable distribution of people with disabilities and rehabilitation staff in Vietnam, where 75–80% of people with disabilities (at the commune level) have no rehabilitation staff, while in places where only 1–5% of people with disabilities need rehabilitation, the percentage of rehabilitation staff is around 79–85% [ 2 ], [ 4 ], [ 5 ]. Therefore, CBR is the most effective solution to the problem of people with disabilities, and the personnel responsible for implementing the program's techniques must be specifically assigned, as this is a decisive factor for the program's success. Training Needs for Community-Based Rehabilitation of Commune Health Officials 100% of commune health officials expressed a need for training on the eight tasks in the CBR program. The reasons for needing annual training/workshops were to reinforce professional knowledge, meet job requirements, and update new knowledge and skills, with high percentages over 55%, at 59.6%, 57%, and 55.3%, respectively. This result is consistent with the findings of Nguyen Duc Truong and Le Thi Ut Hien [ 11 ], [ 12 ]. The need for training on the tasks was high. The desire for training on the 8 CBR tasks among health officials was high, with the highest being "Processing and synthesizing survey results according to the 'Disability Model' form," at 64.9%. The task of "Processing and synthesizing survey results according to the 'Disability Model' form" is the first and a quite important and complex task in the CBR program. However, according to the results on the current state of training for the 8 CBR tasks for health officials, the percentage of those who have not been trained on this task is the highest. Because this untrained task is also important, the desire for training on "Processing and synthesizing survey results according to the 'Disability Model' form" also has the highest percentage. These study results are also consistent with the results of the CBR study in Laos - comparing needs and services by A Stuelz. This study describes several attempts to implement CBR strategies. However, this attention is limited to the field of medical rehabilitation (amputees and movement-impaired persons). Based on the evidence, the study can conclude that: it is easier to integrate people with disabilities through education programs; there is a need to educate health professionals about the non-medical expectations of any rehabilitation program; and occupational therapists may be the most suitable health professionals to be involved in CBR programs [ 13 ]. Among the group of subjects who desired training, the percentage who wanted training on CBR tasks through workshops was the highest, mostly over 80%, with task 1 and task 7 having the highest percentages of subjects choosing them at 84.2% and 83.3%, respectively. This result is also consistent with the results obtained from the current training status for CBR tasks. The percentage of health officials who have been trained on CBR tasks through workshops is the highest. A workshop is a type of training aimed at exchanging experiences or providing new information in many fields that trainees need. Seeing that the workshop format is effective, the study subjects also desired the workshop training format to have the highest percentage among other formats. In the group of subjects who desired training, the subjects wanted to be trained using all four methods: presentations, group discussions, practice on trainees, and practice on people with disabilities. Meanwhile, the percentage of subjects who wanted to be trained on CBR tasks via group discussions was over 43%. Our study is also consistent with the study by Ellen Wilson et al. on Technology and rehabilitation training for community health workers: Strengthening health systems in Malawi. The purpose of this study was to evaluate a community health worker training program in Malawi that integrated technology into the delivery of rehabilitation services. This study also highlights the importance of evaluating programs in low-resource settings with a focus on feasibility and developing local capacity [ 14 ]. In the group of subjects who desired training, the percentage who wanted to be trained on CBR tasks by provincial-level officials was 50% or more for all tasks, followed by lecturers from the Hanoi University of Public Health, which was 28.9% to 39.5%. In contrast, the percentage of subjects who wanted to be trained by lecturers from the Medical College on CBR tasks was small, ranging from 3.5% to 7.9%. In the group of subjects who desired training, the percentage who wanted the training location for the CBR tasks to be the People's Committee/District, Town, or City Health Center was over 52% for all tasks, followed by the People's Committee/Commune or Ward Health Station, which was 43% to 51.8%. In contrast, the percentage of subjects who wanted to be trained at the Provincial Rehabilitation Hospital on CBR tasks was only a maximum of 28.1%. The training location should be at the District Health Center or the commune/ward health station to save time and travel costs, so that more trainees can fully participate. The desired training duration for CBR tasks for health officials was mostly 1–3 days for all tasks, ranging from 56.1% to 73.7%. Among the subjects with training needs, the desired frequency of continuous training per year for CBR tasks for health officials was highest for one time, followed by two and three times. We find that this desire is also completely consistent with the reality of current commune health stations, where there is a shortage of health staff, so it is impossible to arrange personnel to participate in many training sessions per year. Each session should also be 1–3 days to access a lot of knowledge and absorb it more effectively. This result is consistent with the results of Nguyen Duc Truong's study on the continuous training needs of commune health station staff in Yen Son district, Tuyen Quang province, regarding the number of training sessions and a shorter training duration. This may be because the two study locations are different and the reality of our study subjects is that 1–3 days of training was found to be effective and they don't need a full week. Also, 1–3 days can be scheduled on weekends so as not to affect their work [ 11 ]. The current situation and training needs are related; a task that has not been trained will be desired for training, and a task that has been trained in a reasonable format, method, number of times, and duration will have a training need for that format, method, number of times, and duration if it has not been trained adequately. Training is a need and a desire of all health officials in general and health officials at the station in particular. When attending training courses, trainees want to update new knowledge and skills, reinforce and cultivate professional knowledge, and improve their professional qualifications to perform their assigned tasks well. The CBR training needs of commune health workers are also consistent with the study on the human resource competencies required to implement community rehabilitation in less-resourced settings by Brynne Gilmore et al. The contents of community-based training can allow services to reach more vulnerable populations; supportive and structured supervision is needed at the facility level; core skills may include case management, social protection, monitoring and record keeping, counseling skills, and referral mechanisms; community ownership; training in the CBR matrix and advocacy; a tiered/teamwork system of service delivery; and training should take a rights-based approach, include practical components, and involve people with disabilities in the delivery and planning [27]. The status of community-based rehabilitation for people with psychosocial disabilities in low- and middle-income countries: A systematic review of grey literature by Ana Maria Butura is somewhat similar to our study's findings on the current situation, as Vietnam is also a low- and middle-income country. The CBR programs are primarily located in rural areas or urban areas where a large proportion of the population lives in poverty. They can be classified as livelihood programs, empowerment programs, social programs, health programs, and education programs. Only two programs addressed all five components of the World Health Organization's CBR matrix. The programs reported challenges to implementation, with stigma and lack of resources [ 28 ]. The study by Eva Y. Chung & Tanya L. Packer on the outcomes and impact of community-based rehabilitation programs in Chinese communities aimed to identify the most common and most valued outcomes of community-based rehabilitation (CBR) in Chinese communities and map these to the CBR evaluation framework. The results from all programs were primarily stories focusing on changes in people with disabilities, alongside descriptions of aspects of program development, CBR workers, and advocacy. The conclusion was that CBR practice in Chinese communities remains oriented toward a functional rehabilitation approach rather than community-based inclusive development [ 29 ]. Conclusion All study subjects expressed a desire for CBR training, mostly in the form of workshops. The training content needs to focus on comprehensive information about the eight tasks and the activities of health officials related to CBR. Special attention should be given to training knowledge and practice on CBR tasks to effectively apply the CBR program for people with disabilities and their caregivers. It is necessary to strengthen periodic and continuous training for commune health officials in charge of and implementing the CBR program. Training courses should be organized at the district and commune levels for 1–3 days, covering basic CBR knowledge and skills. It is necessary to organize direct workshop classes for local health officials, taught by health officials from the district level and above, at the district and commune People's Committees to be close to the health officials' workplace, in order to enhance their knowledge and practice on the 8 tasks related to CBR activities so that health officials can apply them at their health facilities and support caregivers and people with disabilities. It is necessary to strengthen network activities for rehabilitation care from the central to local levels to support people with disabilities. Commune health stations should clearly assign officials in charge of or participating in the CBR program to deploy CBR programs more effectively. Policies and funding are needed to strengthen training for village health officials and ensure stipends for village health officials so they can participate in CBR activities under the guidance of commune health officials. Abbreviations IDI: in-depth interviews; FGD: two focus group discussions; LMICs: low- and middle-income countries; CBR: community-based rehabilitation. Declarations Acknowledgments The authors would like to acknowledge the support of the participants in Thanh Chuong district, Nghe An province and the Medical Services Administration Department, Ministry of Health, Vietnam. We would like to thank for English editing of the paper. Fundings This study was sponsored by Hanoi University of Public Health, Vietnam in the project “Healthcare and rehabilitation for toxic chemical poison victims/dioxin in the period 2018-2021”. No fundings were provided for the planning, writing, or submission of the manuscript. Disclosure of interest The authors declare there was no conflict of interest in producing this paper. Ethical approval and consent to participate Ethical approval was received from the Institutional Review Board in Vietnam of Hanoi University of Public Health in Vietnam. The study received ethics approval from the Hanoi University Institutional Ethical Review Board (Approval number 131/2022/YTCC-HD). All primary data collection was conducted after obtaining informed consent from each participant and ensuring the reporting of results protected the participants’ identities. In this study, all methods were carried out in accordance with relevant guidelines and regulations. Consent for publication All participants provided informed consent (Consent to Participate and Consent to Publish) for the manuscript. Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available due to the privacy of research participants but are available from the corresponding author on reasonable request. Author contributions NTH and BLC conceived and designed the study. NTHL, NMA, NTH coordinated data collection and BLC, NTH analysed the data. NTH wrote the first draft of the manuscript. All the authors made critical revisions and agreed on the final versions of the manuscript. NTH, BLC reviewed and revised the manuscript, and NTH approved the final draft for submission, which was done by NTH. References UNICEF. 2017. The state of The World’s children 2016- 2017: Children with disabilities. New York: UNICEF. Hai TT, Thuy NTM. 2012. Management and organization of rehabilitation for victims of chemical/Dioxin poisoning integrated into the Community-Based Rehabilitation program. Hanoi: Medical Publishing House. p. 152–190. WHO. 2011. World report on disability. Geneva: WHO Press, World Health Organization. Health Mo. 2016. List of diseases and defects related to the exposure of chemical toxics/Dioxin. (Vol. 09/2008/QD-BYT). Hanoi: Ministry of Health. Nghien NX, Chau CM, Chuong TV, Hanh VTB. 2011. Physiotherapy – Rehabilitation, Monograph for Rehabilitation Staff. Hanoi: Hanoi Medical Publishing House. p. 83–108. Hai TT, Thuy NTM. 2017. Teaching materials on community-based rehabilitation for grassroots health workers. Hanoi: Medical Publishing House. p. 53–123. Nguyen HT, et al: Status of community-based rehabilitation activities at commune health stations in a district of Nghe An province," Journal of Public Health, 2023. Gilmore B, et al . 2017. A study of human resource competencies required to implement community rehabilitation in less resourced settings. Hum Resour Health. 15 (1): 70. doi: 10.1186/s12960-017-0240-1. Gale L, Gillis S, Grills N. 2022. Determining the vocational competencies required to deliver community-based rehabilitation and inclusive development services in India. Disabil Rehabil. 44(17): 4929–4943. doi: 10.1080/09638288.2021.1907622. Chung EY. 2019. Facilitating learning of community-based rehabilitation through problem-based learning in higher education. BMC Med Educ. 19 (1): 433. doi: 10.1186/s12909-019-1868-4. Truong ND. 2016. Status of task performance and continuous training needs of commune health station staff in Tien Son district, Tuyen Quang province, 2016-2020. [Second-degree specialist thesis]. Tuyen Quang: Health Management. Hien LTU. 2020. Status and continuous training needs of health workers at Tan Thanh district medical center, Long An province, 2017-2019, and some influencing factors. [Master's thesis]. Long An: Hospital Management. Stuelz A. 1999. Community-based rehabilitation in Lao--comparison of needs and services. Disabil Rehabil. 21 (5-6): 269-275. doi: 10.1080/096382899297341. Wilson E, Lee L, Klas R, Nesbit KC. 2020. Technology and rehabilitation training for community health workers: Strengthening health systems in Malawi. Health Soc Care Community. 28 (3): 833-841. doi: 10.1111/hsc.12914. Thang PV. 2017. Status of technical professional task performance and continuous training needs of clinical nurses at Hai Duong Children's Hospital in 2016-2017. [Master's thesis]. Hai Duong: Hospital Management. Nguyen HT, Nguyen TMM, Luu QT, Hoang VB, Tran TT. 2023. Status of community-based rehabilitation activities at commune health stations in a district of Nghe An province. J Public Health. Steiner V, Pierce LL, Salvador D. 2016. Information needs of family caregivers of people with dementia. Rehabil Nurs. 41 (3): 162-169. Health VMo. 2015. Guidance on community-based rehabilitation. Hanoi: Edited by administration Doms. Ho TH. 2019. Information Needs of Caregivers in caring and rehabilitation for dioxin victims. [Research Report]. Ha Noi: Ha Noi University of Public Health. National Assembly of the 12th Legislature. 2010. Law on Persons with Disabilities. (No. 51/2010/QH12). Santin O, Jenkins C, Ho HT, et al. 2019. The development of a web-based support to meet the needs of Informal cancer carers in hospitals in Vietnam. Psycho-Oncology. 29 (5): 920-926. Margaret L. 2013. Cancer caregivers information needs and resource prefereces. J Cancer Educ. 8 : 297-305. Suzanne N. 2003. Information Needs and Coping Styles of Primary Family Caregivers of Women Following Breast Cancer Surgery. Oncol Nurs. 30 : 25-72. Bui CL, et al. 2021. Quality of life, psychological burden, and the need for psychological support for caregivers of children with disabilities in Tinh Gia district, Thanh Hoa province. [Basic research topic]. Ha Noi: Ha Noi University of Public Health. Ho HT, Santin O, Ta HQ, Nguyen TNT, Do UT. 2023. Information needs of informal caregivers in caring and rehabilitation for dioxin victims in Vietnam. BMC Public Health. 23 (1): 1412. Kamiya Y. 2021. Current situation of children with disabilities in low- and middle-income countries. Glob Health Action. 14 (1): 1993433. doi: 10.1080/16549716.2021.1993433. .27. Gilmore B, MacLachlan M, McVeigh J, McClean C, Carr S, Duttine A, Mannan H, McAuliffe E, Mji G, Eide AH, Hem KG, Gupta N. 2017. A study of human resource competencies required to implement community rehabilitation in less resourced settings. Hum Resour Health. 15(1): 70. doi: 10.1186/s12960-017-0240-1. Butura A, Ryan G, Shakespeare T, Ogunmola O, Omobowale O, Greenley R, Eaton J. 2024. Community-based rehabilitation for people with psychosocial disabilities in low- and middle-income countries: a systematic review of the grey literature. Int J Ment Health Syst. doi: 10.1186/s13033-024-00630-0. Chung EY, Packer TL. 2016. Outcomes and impact of community-based rehabilitation programmes in Chinese communities. Disabil Rehabil. 38 (9): 817-821. doi: 10.3109/09638288.2016.1161850. Table 7 Table 7 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table7.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 11 Feb, 2026 Reviews received at journal 04 Feb, 2026 Reviewers agreed at journal 27 Jan, 2026 Reviewers agreed at journal 24 Jan, 2026 Reviews received at journal 19 Jan, 2026 Reviewers agreed at journal 12 Jan, 2026 Reviewers invited by journal 07 Jan, 2026 Editor invited by journal 16 Dec, 2025 Editor assigned by journal 10 Dec, 2025 Submission checks completed at journal 09 Dec, 2025 First submitted to journal 09 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8267271","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":571120420,"identity":"3e52a3eb-d6e8-4698-916a-b575e7de6acf","order_by":0,"name":"Huong Thi 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The results of the household survey show that 7.06% of the population aged 2 and over are disabled. Of the total number of people with disabilities, many persons have multiple disabilities. The highest number of people with is lower mobility (3,566,854 people). The result also shows that 1,219,233 people with self-care disability. There are significant differences between people with disabilities and without disabilities in using health services: medical examination (69.4% versus 51.1%), medical treatment (57.4% versus 36.5%) and function rehabilitation (2.3% versus 0.3%) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The percentage of people with disabilities who need help for daily activities is 26.7%, while only 2.0% in the non-disabled category. The prevalence rate for rural area is almost 1.5 times higher than in urban areas. The region with the highest disability rates is the North Central and Central Coast (NCCC), the lowest are found in the South East (SE) and Central Highlands (CH) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCommunity-Based Rehabilitation is the process of rehabilitation carried out in the community with the participation and joint coordination of people with disabilities, their families, local authorities, grassroots healthcare, and other relevant agencies, organizations, and individuals. Community-Based Rehabilitation has many advantages, is effective, and saves costs for society, people with disabilities, and their families, as well as saving healthcare resources. It is particularly suitable for developing countries [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, limited infrastructure and a significant shortage of Community-Based Rehabilitation personnel hinder the development of rehabilitation activities for people with disabilities. The current situation regarding the distribution of people with disabilities and rehabilitation staff in Vietnam is extremely unreasonable. In areas where the rate of people with disabilities accounts for 75\u0026ndash;80% (commune level), there are no rehabilitation staff. Meanwhile, in areas where only 1\u0026ndash;5% of people with disabilities need rehabilitation, the proportion of rehabilitation staff is about 79\u0026ndash;85% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Thus, Community-Based Rehabilitation is the most effective solution to address the issues of people with disabilities, and the human resources to implement the technical aspects of the program must be specifically assigned. This is a decisive factor for the program's success.\u003c/p\u003e \u003cp\u003eIn 2016, in the whole country Việt Nam, 57.3% of Commune Health Centre (CHC) have rehabilitation programs, 90.6% of CHCs conduct education and disseminate knowledge about health care for people with disabilities and 88.3% of CHCs have logbook for disability tracking. There are many disparities among regions in implementing the rehabilitation programs, percentage of CHCs having the programs is lowest in NMM (39.3%) and highest in SE region (76%). Only 16.9% of CHCs are designed in line with accessibility standards for people with disabilities. Of which, NMM has only 7.8% of CHCs designed for people with disabilities, this proportion is 27.4% and 26.0% respectively in SE and the MRD [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe commune health station acts as the project management board at the commune level, implementing activities. Commune health workers collect data, monitor, and manage the program with the professional support of district and provincial rehabilitation technicians. The activities of commune health workers in the community-based rehabilitation program include 8 tasks: Processing and synthesizing survey results according to the \"Disability Model\" form, Assigning areas of responsibility for rehabilitation to community-based rehabilitation workers, Providing assessment forms for the rehabilitation outcomes of people with disabilities in the community to community-based rehabilitation workers, Monitoring the recording of rehabilitation outcomes by community-based rehabilitation workers on the assessment forms, Preparing content and organizing monthly rehabilitation handovers with community-based rehabilitation workers, Maintaining all records related to people with disabilities in the locality, Reporting difficulties faced by people with disabilities and their families during the rehabilitation process to the People's Committee and relevant departments, sectors, and levels of authority for necessary support, and Contacting higher levels for patient referrals or professional support when needed [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In reality, most communes mainly have lists and management records of people with disabilities, and keep minutes of regular handover meetings between the commune health station and collaborators. Additionally, the health station also has referral records for transferring people with disabilities to higher levels. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e\"Community-based rehabilitation (CBR) staff at health stations are still weak, while community-based rehabilitation heavily relies on these stations. The main activities at commune health stations and village health posts are advocacy and communication about community-based rehabilitation, alongside record-keeping and regular screening examinations for people with disabilities as mentioned above. At the commune level, the workload is high while human resources are limited, so advocacy activities are carried out more frequently [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe minimum training requirements for community-based rehabilitation workers should integrate aspects of disability identification, referral techniques, record-keeping, case management, as well as mobilization techniques and knowledge transfer to the community. Community workers need to be trained in basic counseling techniques and mental health referral mechanisms. Community rehabilitation workers must have knowledge of the Community-Based Rehabilitation Matrix, as well as social protection and potential contextual challenges in their area [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Meeting the rehabilitation and inclusion needs of people with disabilities in low- and middle-income countries requires adequately trained local staff. Currently, a lack of knowledge and understanding of the necessary competencies of community-based rehabilitation workers is affecting the quality of training and the workforce [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe quality of community-based rehabilitation (CBR) personnel is a key factor contributing to the success of community-based rehabilitation programs [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, the current state of training in community-based rehabilitation is not widespread or standardized, and the methods of carrying out tasks and activities within those tasks are inconsistent.\u003c/p\u003e \u003cp\u003eCurrently, there are some studies on the knowledge, attitudes, and practices, and task performance of community-based rehabilitation workers, community-based rehabilitation collaborators, community-based rehabilitation program secretaries, and community-based rehabilitation programs. However, we have found very few studies on the community-based rehabilitation training needs of health staff in charge of the community-based rehabilitation program at the station.\u003c/p\u003e \u003cp\u003eFor these reasons, the research team wants to understand the training needs of commune health station staff in Thanh Chuong district, Nghe An province, to contribute to proposing solutions to strengthen community-based rehabilitation activities of health stations and improve the capacity of health station staff in charge of the community-based rehabilitation program.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e The study was conducted on 114 subjects selected via quantitative sampling and 24 individuals selected via purposive sampling (qualitative), who were health officials at the commune level from commune health stations, commune people's committees, district health officials, labor department officials, and village health workers in Thanh Chuong district, Nghe An province, in 2021\u0026ndash;2022. The results are presented as follows: general information about the study subjects and their training needs regarding the eight tasks in the community-based rehabilitation program.\u003c/p\u003e \u003cp\u003e \u003cb\u003eCharacteristics of the study subjects\u003c/b\u003e \u003c/p\u003e \u003cp\u003eOf the 114 study subjects, 80 were female, accounting for 70.2%. The age group with the highest percentage was 30\u0026ndash;49 years old, making up about half of the study subjects. The average age of the subjects was 40.36\u0026thinsp;\u0026plusmn;\u0026thinsp;7.994 years. The educational level of the study subjects was highest for college graduates, at 50.0%. The main majors of the study subjects were nursing and general medicine, accounting for 28.9% and 14%, respectively, with no one having a rehabilitation major among the subjects (Table\u0026nbsp;3.1).\u003c/p\u003e \u003cp\u003e \u003cb\u003eCurrent status and format of training on CBR tasks for health workers\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe lack of training on all eight CBR tasks for health officials was quite high, over 89%. The highest percentage was for the task \"Processing and synthesizing survey results according to the 'Disability Model' form,\" at 95.6%. Among the health officials who had been trained on CBR tasks, the primary training format was a workshop (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe qualitative interview results were consistent with the quantitative results. The eight CBR tasks for commune health officials were rarely performed. The task of \"Storing all records related to people with disabilities and contacting the upper level to transfer patients or for professional support when needed\" was performed more frequently than the others, as shared by a head of a health station:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eRehabilitation projects and activities in the locality are almost non-existent, and home-based rehabilitation guidance has also been almost entirely unfulfilled (IDI 5, Commune Health Official).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThere is a need for a rehabilitation training program to be implemented synchronously at the local level. Synchronization in training and program implementation will help make the implementation and supervision processes more effective. As a health official shared:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThe effectiveness of the activities is not high because health workers and village health collaborators have not been adequately trained to be truly confident in performing and guiding community-based rehabilitation (IDI2, Commune Health Official).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe low effectiveness of community-based guidance programs may also be due to the limited awareness of caregivers for people with disabilities and victims of Dioxin exposure, as a health official shared, \"\u003cem\u003ethe family cannot do the things I guide them to do.\"\u003c/em\u003e\u003c/p\u003e \u003cp\u003eIn reality, commune and village health officials and collaborators are rarely trained. Periodic training on care and rehabilitation for the grassroots level is generally very limited, and training primarily happens when sponsored by a project. As shared by many health officials at the commune health stations who participated in the study, some commune health officials have been trained in rehabilitation once or twice. Their knowledge is mainly from \"self-study,\" \"doing it themselves.\" The study results show the necessity of increasing training for grassroots health officials on care and rehabilitation for people with disabilities and/or victims of Dioxin exposure. A district health official in charge of rehabilitation shared that they themselves have not received much training in rehabilitation.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eYes, because the team also wants to participate and organize training to provide guidance to the grassroots level, so we know how to implement things when the grassroots level has guidance/ Secondly, since implementation started, it's been pretty much self-study, self-exploration, and just doing it on our own, without any training (IDI 5, Commune Health Official).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe in-depth interviews also show the need for continuous training for collaborators so they can competently guide caregivers of people with disabilities and victims of Dioxin exposure. To do this, funding is needed for workshops as well as stipends for collaborators to perform the task of guiding patients' families in the community.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eCounseling is good, but specific guidance is needed. The important thing is what the collaborators should do? If they get trained but then do nothing, it's useless. And how do we guide them now? The guidance must require them to guide a certain number of people a certain number of times each month; we have that function and responsibility. But they need a policy for them because there are times when they are busy with other things (IDI 1, District Health Official).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe qualitative interview results show the necessity of a rehabilitation training program to be implemented synchronously at the local level. In particular, for commune health officials to perform their assigned functions in community-based rehabilitation, continuous, skills-based training with supervision is needed. As shared in interviews with district and commune health officials, synchronization in training and program implementation will help make the implementation and supervision processes more effective:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003ePreparing the content for the briefing meeting is naturally done, but there's no single unified standard yet. To know what content needs to be standardized, we need training. Records are stored, but how to store them to classify which ones need to be archived and which do not? Reporting difficulties during the process... this is related to the advisory work of the district health department (IDI1, District Health Official).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eWhen doing anything, we need synchronization, guidance, discussion, and record-keeping to be synchronized from top to bottom, so when we provide guidance, and health officials implement it, the inspection and supervision will also be effective (IDI2, Commune Health Official).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe qualitative interview results show that direct workshop training is appropriate. Furthermore, those participating in the training need to be professionals with the ability to convey knowledge, but do not necessarily need to have high qualifications.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eIt doesn't necessarily have to be someone with a high degree or anything, what's important is that they can convey the knowledge to the people being trained, what's important is that they understand (FGD1, Health Official).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe selection of officials to participate in the workshops was also mentioned in the interviews. Some health officials believe that many officials should be sent to training in rotation and that enthusiastic officials who are committed to their work at the station should be chosen to maintain long-term guidance activities in the community. \"First, it must be related to the officials; we must find people with professional knowledge who are enthusiastic about their work.\"\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eIf conditions are too difficult, we can organize one class at the district level, but if there's an abundance, we can organize it by bureau. For a district with 5 locations, it would certainly be of higher quality than training at a single location. Because if we organize it at one location and need many people, the station might send someone else who doesn't have rehabilitation expertise as a substitute, and the discussion won't be good because the person being trained might have an unexpected absence. If we organize it at multiple locations, the stations can send 2\u0026ndash;3 people because it's nearby, so they can go, or if one can't go today, they can go to another training location tomorrow, thus achieving higher effectiveness (IDI1, District Health Official).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eTraining needs on CBR for commune health workers\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe study results show that 100% of commune health officials expressed a need for training on the eight tasks in the CBR program (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe qualitative interview results also show that commune health officials all desire rehabilitation training because they have had little to no training. This lack of knowledge about rehabilitation makes them unconfident in performing activities to support people in the community with rehabilitation.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eMy station really wants even the station staff and village health workers to be able to provide guidance. You guys should guide them on rehabilitation. As a doctor myself, I can't give in-depth guidance because I'm a general practitioner (IDI 3, Health Official).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eOfficials who are trained in rehabilitation do attend workshops, but first, they attend software workshops. As for rehabilitation skills workshops, I haven't attended any. I would really want to participate if there was a training class. You guys should open a skills class and train the station head so I can participate. But now with rehabilitation content, no one comes and no one has a policy to hold a refresher workshop. To be honest, that person's skills also belong to pedagogical skills\u0026mdash;how they convey it and how people absorb it? If they can't absorb it, then it's a wash (FGD1, Health Official).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eMost home-based rehabilitation guidance activities under the community-based rehabilitation program have not been carried out.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eIn terms of management, my station manages everything, all of it. All people with disabilities, including those with mental illness, those who receive benefits, I have a list from beginning to end. My station has a specific management list. But to talk about examinations, people only come for check-ups when they're sick; we don't proactively go to them. Do you understand what I mean? For example, in this one month, you should at least go to one village and select 10 people to guide. That's what the training says, but I haven't been able to do it. I'll be frank, I haven't been able to do it, and the reality is that most communes haven't been able to either (IDI 4, Commune Health Official).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e Some commune health officials who participated in the interviews expressed a desire for the commune health official in charge of rehabilitation to be trained regularly to be able to carry out rehabilitation activities in the commune, such as using software and supporting people with disabilities, especially now that the COVID pandemic is not as severe as before.\u003c/p\u003e \u003cp\u003eCommune health officials also believe that village health workers need to be trained in rehabilitation and care for people with disabilities so they can directly support patients in the community.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eActually, going and knocking on each door to guide them, like we said, to guide them monthly, hasn't been done. They're locals there; the village health workers are directly there, so they can provide the guidance (IDI 4, Health Official).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eHowever, in reality, some policy barriers for village health workers in Vietnam today make it difficult to recruit them to participate in rehabilitation activities. As a commune health official shared, funding for village health workers has been cut in recent years, which has greatly affected their participation. Most of them participate as volunteers.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eIn terms of both the training program and skills, I want to say that my station hopes to train the team of village health workers and the station's nurses so they can work more practically and have a certain level of professional expertise. At the very least, the station should have one official who specializes in rehabilitation so they understand and can pass it on to their staff, like nurses and orderlies. To be honest with you, in the past, all the project programs had money, but village health workers only got 0.3. With a subsidy of 0.3, what can they do? It's only a few hundred [thousand dong]. According to the new regulations from the Ministry of Health, my commune, which is an especially difficult one, should get 0.5, but now they've cut all of it. Village health workers don't even have 0.3 multiplied, so they only get a few hundred, so they don't do it. Honestly, even if you try to motivate them, they won't do it. If they do, it's just to be supportive, so only the enthusiastic ones, what they call volunteers in other countries, are the right ones. So they should be put in the case of volunteers (IDI 6, Health Official).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eTherefore, some commune health officials proposed that financial support is needed for village health workers to participate in the community-based rehabilitation program.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eFor example, if we have a proper compensation policy for them, and village health workers get a worthy compensation, they will do specialized work and no other jobs anymore. They will focus on their expertise, like in mountainous areas, they won't have to work on their farms to earn extra income but will focus on their professional work, so if rehabilitation is needed, they will go right to the location (FGD1, Health Official).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eReasons for needing annual training/retraining\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe reasons for needing annual training/retraining were to consolidate professional knowledge, serve job needs, and update new knowledge and skills, with high percentages over 55% at 59.6%, 57%, and 55.3%, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eDesired training content on commune health officials' tasks in community-based rehabilitation activities\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe desire for training on the eight community-based rehabilitation tasks for health officials was high, with the highest being \"Processing and synthesizing survey results according to the 'Disability Model' form,\" at 64.9% (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Among the group of subjects who desired training, the percentage who wanted training on the community-based rehabilitation tasks through workshops was the highest, mostly over 80%, with tasks 1 and 7 having the highest percentages of subjects choosing them at 84.2% and 83.3%, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). In the group of subjects who desired training, the subjects wanted to be trained using all four methods: presentations, group discussions, practice on trainees, and practice on people with disabilities. Meanwhile, the percentage of subjects who wanted to be trained on community-based rehabilitation tasks via group discussions was over 43% (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe qualitative results show that most health officials who participated in workshops want to continue participating in training programs because they want better knowledge and skills in care and rehabilitation. A short training duration of about 1\u0026ndash;3 days is suitable, and this result is consistent with the quantitative result.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI attended one morning and found it very useful in helping them take better care of patients. And they called me and asked if they should buy a large spoon, which I could help with, or a towel, which is more difficult to wash daily. Overall, I don't have many comments on the other content; it's all good. The time is also suitable. I only participated in one session, so I don't know much. In my opinion, training for caregivers for 1\u0026ndash;2 days is suitable because people in rural areas have a lot of work and can't go. The location at the People's Committee is very good. The lecturers are very enthusiastic and explain things meticulously. I haven't participated much, so I don't have many additional comments (IDI 4, Commune Health Official).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eDesired trainers and training locations for community-based rehabilitation tasks for health officials\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAmong the group of subjects who desired training, the percentage who wanted to be trained on the community-based rehabilitation tasks by provincial-level officials was 50% or more for all tasks, followed by lecturers from the Hanoi University of Public Health, which was 28.9% to 39.5%. In contrast, the percentage of subjects who wanted to be trained by lecturers from the Medical College was small, ranging from 3.5% to 7.9% (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). In the group of subjects who desired training, the percentage who wanted the training location for the community-based rehabilitation tasks to be the People's Committee/District, Town, or City Health Center was over 52% for all tasks, followed by the People's Committee/Commune or Ward Health Station, which was 43% to 51.8%. In contrast, the percentage of subjects who wanted to be trained at the Provincial Rehabilitation Hospital on the community-based rehabilitation tasks was only a maximum of 28.1% (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe qualitative interview results show similar results regarding the desire for training on the content of the community-based rehabilitation program. The proposed locations were mostly the People's Committee, and lecturers who taught meticulously and in detail. As a commune health official shared:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eThe location at the People's Committee is very good. The lecturers are very enthusiastic and explain things meticulously. I haven't participated much, so I don't have many additional comments (IDI4, Commune Health Official).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eDesired duration and frequency of training on community-based rehabilitation tasks for health officials\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe desired training duration for community-based rehabilitation tasks for health officials was mostly 1\u0026ndash;3 days for all tasks, ranging from 56.1% to 73.7% (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). Among the subjects with training needs, the desired frequency of continuous training per year for community-based rehabilitation tasks for health officials was highest for one time, followed by two times and three times (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe qualitative results show that most health officials who participated in workshops want to participate in training programs because they want better knowledge and skills in care and rehabilitation. A short training duration of about 1\u0026ndash;3 days is suitable, and this result is consistent with the quantitative result.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eI attended one morning and found it very useful in helping them take better care of patients. And they called me and asked if they should buy a large spoon, which I could help with, or a towel, which is more difficult to wash daily. Overall, I don't have many comments on the other content; it's all good. The time is also suitable. I only participated in one session, so I don't know much. In my opinion, training for caregivers for 1\u0026ndash;2 days is suitable because people in rural areas have a lot of work and can't go. The location at the People's Committee is very good. The lecturers are very enthusiastic and explain things meticulously. I haven't participated much, so I don't have many additional comments (IDI 4, Commune Health Official).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003e3. Tables\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eCharacteristics the study subjects\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (29.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80 (70.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eAge groups (years old)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (9.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (44.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (29.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (14.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean age (years old) (Min-Max)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.36\u0026thinsp;\u0026plusmn;\u0026thinsp;7.994 (26\u0026ndash;60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u003cb\u003eEducation levels\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eElementary level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle school level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (22.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollege\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (25.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePostgraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther (Secondary school)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"12\" rowspan=\"13\"\u003e \u003cp\u003e\u003cb\u003eMajor\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRehabilitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraditional medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (9.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (14)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (12.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (28.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMidwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (13.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical Technician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePharmacist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (13.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDemography\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (7.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNutrition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreventive Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublic Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e114 (100%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCurrent status and format of training on CBR tasks for health workers\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eJob Responsibilities of a Commune Health Worker\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCurrent status of training\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c8\" namest=\"c4\"\u003e \u003cp\u003eTraining format\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUntrained\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTrained\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWorkshop/\u003c/p\u003e \u003cp\u003eConference\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTraining course\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStandardized training\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDistance learning\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eWebsite on CBR/Disabilities\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcess and compile survey results according to the \"Disability Model\" form.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109 (95.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssign areas of responsibility for rehabilitation to community-based rehabilitation staff.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107 (93.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProvide evaluation forms for rehabilitation outcomes of people with disabilities in the community to community-based rehabilitation staff.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e105 (92.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonitor the recording of rehabilitation outcomes by community-based rehabilitation staff on the evaluation forms.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102 (89.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrepare content and organize monthly rehabilitation meetings with community-based rehabilitation staff.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e103 (90.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaintain all records related to people with disabilities in the locality.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102 (89.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReport difficulties of people with disabilities and their families in the rehabilitation process to the People's Committee and relevant departments, branches, and authorities at all levels for necessary support.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102 (89.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContact higher levels for patient transfer or professional support when needed.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104 (91.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTraining needs on CBR for commune health workers\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraining needs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeed training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo not need training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTổng\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e114\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReasons for needing annual training/retraining\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReasons\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo meet job requirements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo reinforce professional knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo improve professional skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo update new knowledge and skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTo improve professional level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDue to changes in disease/disability patterns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDesired content, format, and method of training on the duties of commune health workers in community-based rehabilitation activities.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContents\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e \u003cp\u003eDesired format\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c11\" namest=\"c8\"\u003e \u003cp\u003eDesired training method\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eContent of CBR tasks\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWorkshop/\u003c/p\u003e \u003cp\u003eConference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTraining course\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStandardized training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDistance learning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eWebsite on CBR/Disabilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePresentations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eGroup discussions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ePracticing on students\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003ePracticing on people with disabilities\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcess and compile survey results according to the \"Disability Model\" form.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74 (64.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e44 (38.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e49 (43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e36 (31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e47 (41.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssign areas of responsibility for rehabilitation to community-based rehabilitation staff.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91 (79.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e37 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e55 (48.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e35 (30.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e44 (38.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProvide evaluation forms for rehabilitation outcomes of people with disabilities in the community to community-based rehabilitation staff.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (40.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89 (78.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16 (14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e37 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e55 (48.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e38 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e44 (38.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonitor the recording of rehabilitation outcomes by community-based rehabilitation staff on the evaluation forms.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93 (81.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e43 (37.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e57 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e30 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e42 (36.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrepare content and organize monthly rehabilitation meetings with community-based rehabilitation staff.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (43.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94 (82.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e44 (38.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e51 (44.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e37 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e41 (36.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaintain all records related to people with disabilities in the locality.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93 (81.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11 (9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e41 (36.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e53 (46.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e37 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e42 (36.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReport difficulties of people with disabilities and their families in the rehabilitation process to the People's Committee and relevant departments, branches, and authorities at all levels for necessary support.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (20.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96 (84.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10 (8.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e39 (34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e51 (44.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e37 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e43 (37.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContact higher levels for patient transfer or professional support when needed.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (19.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94 (82.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e39 (34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e57 (50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e32 (28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e37 (32.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDesired officers and training locations for community-based rehabilitation duties for health workers.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eContent of CBR tasks\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eDesired training officer\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e \u003cp\u003eDesired location\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCentral-level officer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProvincial-level officer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDistrict-level officer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLecturer from the Hanoi University of Public Health\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eLecturer from the College of Health\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eProvincial Rehabilitation Hospital\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePeople's Committee/ District, Town, City Health Center\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePeople's Committee/ Commune, Ward Health Station\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcess and compile survey results according to the \"Disability Model\" form.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (50.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45 (39.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28 (24.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e69 (60.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e49 (43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssign areas of responsibility for rehabilitation to community-based rehabilitation staff.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (20.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (56.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (27.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45 (39.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e30 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e60 (52.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e56 (49.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProvide evaluation forms for rehabilitation outcomes of people with disabilities in the community to community-based rehabilitation staff.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (51.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 (35.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e34 (29.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e62 (54.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e53 (46.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonitor the recording of rehabilitation outcomes by community-based rehabilitation staff on the evaluation forms.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (55.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (29.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 (35.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29 (25.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e63 (55.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e56 (49.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrepare content and organize monthly rehabilitation meetings with community-based rehabilitation staff.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (55.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42 (36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 (7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28 (24.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e66 (57.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e54 (47.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaintain all records related to people with disabilities in the locality.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (56.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (34.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29 (25.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e63 (55.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e59 (51.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReport difficulties of people with disabilities and their families in the rehabilitation process to the People's Committee and relevant departments, branches, and authorities at all levels for necessary support.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (22.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (57.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (28.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e32 (28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e61 (53.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e56 (49.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContact higher levels for patient transfer or professional support when needed.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (19.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (57.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (29.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42 (36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e32 (28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e60 (52.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e56 (49.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis cross-sectional study, conducted in Thanh Chuong District, Nghe An Province from December 2021 to June 2022, used a mixed-methods approach. For the quantitative component, a total sampling method was used, surveying 114 health staff from all communes, including the head of each health station and two staff members involved in the community-based rehabilitation (CBR) program. Subjects were required to be at least 18 years old and actively working at a commune health station. For the qualitative component, purposive sampling was used to select 24 key informants from various levels, including commune and district health staff, provincial health department staff, and local government officials, who were knowledgeable about CBR. Quantitative data were collected through direct interviews using a structured questionnaire that had been pilot-tested and revised. The questionnaire focused on the current status and training needs related to CBR. Data were analyzed using SPSS 22.0, with descriptive statistics applied to the research variables (training needs, content, methods, location, frequency, and duration). Qualitative data were collected through in-depth interviews and focus group discussions lasting 45\u0026ndash;60 minutes, guided by a semi-structured interview guide. Thematic analysis was used to analyze this data. The study was approved by the Ethics Committee of the Hanoi University of Public Health (Decision No. 131/2022/YTCC-HD3). All participants provided informed consent and were assured of confidentiality and the right to withdraw. To ensure data accuracy, the research team directly supervised data collection and randomly rechecked 10% of the completed questionnaires.\u003c/p\u003e"},{"header":"Discussions","content":"\u003cp\u003eThis is the first study to investigate the CBR training needs of commune health officials in Nghe An province, Vietnam. The findings show a high demand for CBR training to provide rehabilitation for more people with disabilities. However, the CBR training needs in this study do not include the CBR training needs of caregivers and people with disabilities themselves, or of village health workers, to enable self-rehabilitation for people with disabilities and their caregivers.\u003c/p\u003e \u003cp\u003e \u003cb\u003eGeneral Information on Study Subjects\u003c/b\u003e \u003c/p\u003e \u003cp\u003eRegarding the general characteristics of the study subjects, out of the 114 subjects, 70.2% were female. This result, being high at over 70%, is consistent with the findings of a 2016 study by Nguyen Duc Truong et al. on commune health station staff in Yen Son district, Tuyen Quang province [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe age group with the highest percentage was 30\u0026ndash;49 years old, which accounted for about half of the study subjects. The average age of the subjects was 40.36\u0026thinsp;\u0026plusmn;\u0026thinsp;7.994 years. This result is also consistent with the findings of Nguyen Duc Truong's study on the current state of task performance and continuous training needs of commune health station staff in Yen Son district, Tuyen Quang province. In Nguyen Duc Truong's study, the 31\u0026ndash;50 age group also accounted for 58.78%, over 50% of the study subjects [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The subjects' highest educational level was a college degree, at 50.0%. The main majors of the subjects were nursing and general medicine, with percentages of 28.9% and 14%, respectively. No one in the study group had a rehabilitation major. This is consistent with the current situation of an extremely unreasonable distribution of people with disabilities and rehabilitation staff in Vietnam, where 75\u0026ndash;80% of people with disabilities (at the commune level) have no rehabilitation staff, while in places where only 1\u0026ndash;5% of people with disabilities need rehabilitation, the percentage of rehabilitation staff is around 79\u0026ndash;85% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Therefore, CBR is the most effective solution to the problem of people with disabilities, and the personnel responsible for implementing the program's techniques must be specifically assigned, as this is a decisive factor for the program's success.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTraining Needs for Community-Based Rehabilitation of Commune Health Officials\u003c/b\u003e \u003c/p\u003e \u003cp\u003e100% of commune health officials expressed a need for training on the eight tasks in the CBR program. The reasons for needing annual training/workshops were to reinforce professional knowledge, meet job requirements, and update new knowledge and skills, with high percentages over 55%, at 59.6%, 57%, and 55.3%, respectively. This result is consistent with the findings of Nguyen Duc Truong and Le Thi Ut Hien [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The need for training on the tasks was high. The desire for training on the 8 CBR tasks among health officials was high, with the highest being \"Processing and synthesizing survey results according to the 'Disability Model' form,\" at 64.9%. The task of \"Processing and synthesizing survey results according to the 'Disability Model' form\" is the first and a quite important and complex task in the CBR program. However, according to the results on the current state of training for the 8 CBR tasks for health officials, the percentage of those who have not been trained on this task is the highest. Because this untrained task is also important, the desire for training on \"Processing and synthesizing survey results according to the 'Disability Model' form\" also has the highest percentage.\u003c/p\u003e \u003cp\u003eThese study results are also consistent with the results of the CBR study in Laos - comparing needs and services by A Stuelz. This study describes several attempts to implement CBR strategies. However, this attention is limited to the field of medical rehabilitation (amputees and movement-impaired persons). Based on the evidence, the study can conclude that: it is easier to integrate people with disabilities through education programs; there is a need to educate health professionals about the non-medical expectations of any rehabilitation program; and occupational therapists may be the most suitable health professionals to be involved in CBR programs [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong the group of subjects who desired training, the percentage who wanted training on CBR tasks through workshops was the highest, mostly over 80%, with task 1 and task 7 having the highest percentages of subjects choosing them at 84.2% and 83.3%, respectively. This result is also consistent with the results obtained from the current training status for CBR tasks. The percentage of health officials who have been trained on CBR tasks through workshops is the highest. A workshop is a type of training aimed at exchanging experiences or providing new information in many fields that trainees need. Seeing that the workshop format is effective, the study subjects also desired the workshop training format to have the highest percentage among other formats.\u003c/p\u003e \u003cp\u003eIn the group of subjects who desired training, the subjects wanted to be trained using all four methods: presentations, group discussions, practice on trainees, and practice on people with disabilities. Meanwhile, the percentage of subjects who wanted to be trained on CBR tasks via group discussions was over 43%.\u003c/p\u003e \u003cp\u003eOur study is also consistent with the study by Ellen Wilson et al. on Technology and rehabilitation training for community health workers: Strengthening health systems in Malawi. The purpose of this study was to evaluate a community health worker training program in Malawi that integrated technology into the delivery of rehabilitation services. This study also highlights the importance of evaluating programs in low-resource settings with a focus on feasibility and developing local capacity [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the group of subjects who desired training, the percentage who wanted to be trained on CBR tasks by provincial-level officials was 50% or more for all tasks, followed by lecturers from the Hanoi University of Public Health, which was 28.9% to 39.5%. In contrast, the percentage of subjects who wanted to be trained by lecturers from the Medical College on CBR tasks was small, ranging from 3.5% to 7.9%.\u003c/p\u003e \u003cp\u003eIn the group of subjects who desired training, the percentage who wanted the training location for the CBR tasks to be the People's Committee/District, Town, or City Health Center was over 52% for all tasks, followed by the People's Committee/Commune or Ward Health Station, which was 43% to 51.8%. In contrast, the percentage of subjects who wanted to be trained at the Provincial Rehabilitation Hospital on CBR tasks was only a maximum of 28.1%. The training location should be at the District Health Center or the commune/ward health station to save time and travel costs, so that more trainees can fully participate.\u003c/p\u003e \u003cp\u003eThe desired training duration for CBR tasks for health officials was mostly 1\u0026ndash;3 days for all tasks, ranging from 56.1% to 73.7%. Among the subjects with training needs, the desired frequency of continuous training per year for CBR tasks for health officials was highest for one time, followed by two and three times. We find that this desire is also completely consistent with the reality of current commune health stations, where there is a shortage of health staff, so it is impossible to arrange personnel to participate in many training sessions per year. Each session should also be 1\u0026ndash;3 days to access a lot of knowledge and absorb it more effectively. This result is consistent with the results of Nguyen Duc Truong's study on the continuous training needs of commune health station staff in Yen Son district, Tuyen Quang province, regarding the number of training sessions and a shorter training duration. This may be because the two study locations are different and the reality of our study subjects is that 1\u0026ndash;3 days of training was found to be effective and they don't need a full week. Also, 1\u0026ndash;3 days can be scheduled on weekends so as not to affect their work [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe current situation and training needs are related; a task that has not been trained will be desired for training, and a task that has been trained in a reasonable format, method, number of times, and duration will have a training need for that format, method, number of times, and duration if it has not been trained adequately. Training is a need and a desire of all health officials in general and health officials at the station in particular. When attending training courses, trainees want to update new knowledge and skills, reinforce and cultivate professional knowledge, and improve their professional qualifications to perform their assigned tasks well.\u003c/p\u003e \u003cp\u003eThe CBR training needs of commune health workers are also consistent with the study on the human resource competencies required to implement community rehabilitation in less-resourced settings by Brynne Gilmore et al. The contents of community-based training can allow services to reach more vulnerable populations; supportive and structured supervision is needed at the facility level; core skills may include case management, social protection, monitoring and record keeping, counseling skills, and referral mechanisms; community ownership; training in the CBR matrix and advocacy; a tiered/teamwork system of service delivery; and training should take a rights-based approach, include practical components, and involve people with disabilities in the delivery and planning [27].\u003c/p\u003e \u003cp\u003eThe status of community-based rehabilitation for people with psychosocial disabilities in low- and middle-income countries: A systematic review of grey literature by Ana Maria Butura is somewhat similar to our study's findings on the current situation, as Vietnam is also a low- and middle-income country. The CBR programs are primarily located in rural areas or urban areas where a large proportion of the population lives in poverty. They can be classified as livelihood programs, empowerment programs, social programs, health programs, and education programs. Only two programs addressed all five components of the World Health Organization's CBR matrix. The programs reported challenges to implementation, with stigma and lack of resources [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study by Eva Y. Chung \u0026amp; Tanya L. Packer on the outcomes and impact of community-based rehabilitation programs in Chinese communities aimed to identify the most common and most valued outcomes of community-based rehabilitation (CBR) in Chinese communities and map these to the CBR evaluation framework. The results from all programs were primarily stories focusing on changes in people with disabilities, alongside descriptions of aspects of program development, CBR workers, and advocacy. The conclusion was that CBR practice in Chinese communities remains oriented toward a functional rehabilitation approach rather than community-based inclusive development [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAll study subjects expressed a desire for CBR training, mostly in the form of workshops. The training content needs to focus on comprehensive information about the eight tasks and the activities of health officials related to CBR. Special attention should be given to training knowledge and practice on CBR tasks to effectively apply the CBR program for people with disabilities and their caregivers. It is necessary to strengthen periodic and continuous training for commune health officials in charge of and implementing the CBR program. Training courses should be organized at the district and commune levels for 1\u0026ndash;3 days, covering basic CBR knowledge and skills. It is necessary to organize direct workshop classes for local health officials, taught by health officials from the district level and above, at the district and commune People's Committees to be close to the health officials' workplace, in order to enhance their knowledge and practice on the 8 tasks related to CBR activities so that health officials can apply them at their health facilities and support caregivers and people with disabilities. It is necessary to strengthen network activities for rehabilitation care from the central to local levels to support people with disabilities. Commune health stations should clearly assign officials in charge of or participating in the CBR program to deploy CBR programs more effectively. Policies and funding are needed to strengthen training for village health officials and ensure stipends for village health officials so they can participate in CBR activities under the guidance of commune health officials.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u0026nbsp;IDI: in-depth interviews; FGD: two focus group discussions; LMICs: low- and middle-income countries; CBR: community-based rehabilitation.\u0026nbsp;\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge the support of the participants in Thanh Chuong district, Nghe An province and the Medical Services Administration Department, Ministry of Health, Vietnam. We would like to thank for English editing of the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFundings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was sponsored by Hanoi University of Public Health, Vietnam in the project \u0026ldquo;Healthcare and rehabilitation for toxic chemical poison victims/dioxin in the period 2018-2021\u0026rdquo;. No fundings were provided for the planning, writing, or submission of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare there was no conflict of interest in producing this paper.\u003c/p\u003e\n\u003cp\u003eEthical approval and consent to participate\u003c/p\u003e\n\u003cp\u003eEthical approval was received from the Institutional Review Board in Vietnam of Hanoi University of Public Health in Vietnam.\u003c/p\u003e\n\u003cp\u003eThe study received ethics approval from the Hanoi University Institutional Ethical Review Board (Approval number 131/2022/YTCC-HD). All primary data collection was conducted after obtaining informed consent from each participant and ensuring the reporting of results protected the participants\u0026rsquo; identities. In this study, all methods were carried out in accordance with relevant guidelines and regulations. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided informed consent (Consent to Participate and Consent to Publish) for the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to the privacy of research participants but are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNTH and BLC conceived and designed the study. NTHL, NMA, NTH coordinated data collection and BLC, NTH analysed the data. NTH wrote the first draft of the manuscript. All the authors made critical revisions and agreed on the final versions of the manuscript. NTH, BLC reviewed and revised the manuscript, and NTH approved the final draft for submission, which was done by NTH.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eUNICEF. 2017. The state of The World\u0026rsquo;s children 2016- 2017: Children with disabilities. New York: UNICEF.\u003c/li\u003e\n\u003cli\u003eHai TT, Thuy NTM. 2012. Management and organization of rehabilitation for victims of chemical/Dioxin poisoning integrated into the Community-Based Rehabilitation program. Hanoi: Medical Publishing House. p. 152\u0026ndash;190.\u003c/li\u003e\n\u003cli\u003eWHO. 2011. World report on disability. Geneva: WHO Press, World Health Organization.\u003c/li\u003e\n\u003cli\u003eHealth Mo. 2016. List of diseases and defects related to the exposure of chemical toxics/Dioxin. (Vol. 09/2008/QD-BYT). Hanoi: Ministry of Health.\u003c/li\u003e\n\u003cli\u003eNghien NX, Chau CM, Chuong TV, Hanh VTB. 2011. Physiotherapy \u0026ndash; Rehabilitation, Monograph for Rehabilitation Staff. Hanoi: Hanoi Medical Publishing House. p. 83\u0026ndash;108.\u003c/li\u003e\n\u003cli\u003eHai TT, Thuy NTM. 2017. Teaching materials on community-based rehabilitation for grassroots health workers. Hanoi: Medical Publishing House. p. 53\u0026ndash;123.\u003c/li\u003e\n\u003cli\u003eNguyen HT, et al: Status of community-based rehabilitation activities at commune health stations in a district of Nghe An province,\u0026quot; Journal of Public Health, 2023.\u003c/li\u003e\n\u003cli\u003eGilmore B, et al . 2017. A study of human resource competencies required to implement community rehabilitation in less resourced settings. Hum Resour Health. \u003cstrong\u003e15\u003c/strong\u003e(1): 70. doi: 10.1186/s12960-017-0240-1.\u003c/li\u003e\n\u003cli\u003eGale L, Gillis S, Grills N. 2022. 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Current situation of children with disabilities in low- and middle-income countries. Glob Health Action. \u003cstrong\u003e14\u003c/strong\u003e(1): 1993433. doi: 10.1080/16549716.2021.1993433.\u003c/li\u003e\n\u003cli\u003e.27. Gilmore B, MacLachlan M, McVeigh J, McClean C, Carr S, Duttine A, Mannan H, McAuliffe E, Mji G, Eide AH, Hem KG, Gupta N. 2017. A study of human resource competencies required to implement community rehabilitation in less resourced settings. Hum Resour Health. 15(1): 70. doi: 10.1186/s12960-017-0240-1.\u003c/li\u003e\n\u003cli\u003eButura A, Ryan G, Shakespeare T, Ogunmola O, Omobowale O, Greenley R, Eaton J. 2024. Community-based rehabilitation for people with psychosocial disabilities in low- and middle-income countries: a systematic review of the grey literature. Int J Ment Health Syst. doi: 10.1186/s13033-024-00630-0.\u003c/li\u003e\n\u003cli\u003eChung EY, Packer TL. 2016. Outcomes and impact of community-based rehabilitation programmes in Chinese communities. Disabil Rehabil. \u003cstrong\u003e38\u003c/strong\u003e(9): 817-821. doi: 10.3109/09638288.2016.1161850.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 7","content":"\u003cp\u003eTable 7 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Training needs, community-based rehabilitation, commune health workers, Vietnam","lastPublishedDoi":"10.21203/rs.3.rs-8267271/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8267271/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eTo identify the training needs regarding Community-Based Rehabilitation (CBR) among commune health workers in Vietnam.\u003c/p\u003e\u003ch2\u003eMaterials and methods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted in Nghe An province from 2021 to 2022. Quantitative data were collected from 114 health workers using structured interviews. Qualitative data were gathered through 16 in-depth interviews (IDI) and 8 focus group discussions (FGD).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe majority of participants were female (70.2%). The primary fields of study were nursing and general medicine, with no participants specialized in rehabilitation. All participants (100%) expressed a need for training, particularly on the \u0026ldquo;Disability Model\u0026rdquo; (64.9%). Health workers preferred training in the form of group discussions, led by instructors from the provincial level or a university. The preferred training locations were district health centers or commune People's Committees. They desired a course duration of 1\u0026ndash;3 days, held once a year.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIt is essential to strengthen continuous, periodic training on CBR knowledge and practical skills for grassroots health workers. These training sessions should be organized as direct workshops at the district and commune levels, led by senior health officials, to better support people with disabilities and their caregivers.\u003c/p\u003e","manuscriptTitle":"Training needs on community-based rehabilitation of commune health workers in Viet Nam","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-08 15:40:28","doi":"10.21203/rs.3.rs-8267271/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-11T09:37:56+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-04T16:58:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"11967535504600004248343921971000654073","date":"2026-01-27T11:40:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"25862947522360103128497074924410357762","date":"2026-01-24T07:16:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-19T08:37:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"121403081667253276900978465141297349946","date":"2026-01-12T06:51:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-07T05:40:09+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-17T04:12:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-10T11:10:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-09T11:35:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-12-09T11:28:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e5117512-ac95-4927-bd11-e69269a9aa9a","owner":[],"postedDate":"January 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-14T08:38:18+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-08 15:40:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8267271","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8267271","identity":"rs-8267271","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}