1.1 Introduction
Visual impairment refers to a significant limitation in vision that cannot be fully corrected with standard glasses, contact lenses, medication, or surgery. It includes both low vision and blindness. According to the World Health Organization (WHO), visual impairment is defined as a visual acuity of less than 6/18 (20/60) in the better eye, even with the best possible correction (World Health Organization, 2019). Visual impairment, affecting millions worldwide, significantly impacts an individual's ability to perform daily activities, leading to social, educational, and economic challenges. CBR involves a combination of efforts from health, education, social, and vocational services within the community, promoting equal opportunities and accessibility. The impact of CBR services on persons with visual impairment is profound, as these programs are tailored to address specific needs such as mobility training, assistive technologies, and vocational training. Research indicates that CBR not only enhances the functional independence of visually impaired individuals but also improves their psychosocial well-being and economic participation (Khasnabis et al., 2010).
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitation of the study and Definition of terms.
1.2 Background of Study
Community based rehabilitation was initiated by the World Health Organization (WHO) in the late 1970s as a response to the lack of access to rehabilitation services for people with disabilities, especially in low- and middle-income countries. It was developed as an alternative to institution-based rehabilitation, which was often inaccessible, expensive, and isolated from the community. The concept has since evolved to become a comprehensive strategy for inclusive development.
The global burden of visual impairment remains a significant public health challenge, with over 285 million people estimated to be visually impaired worldwide, including 39 million who are blind (World Health Organization, 2019). Visual impairment can severely restrict an individual's ability to perform everyday activities, diminishing their quality of life and limiting their social, educational, and economic opportunities.
Community-Based Rehabilitation (CBR) emerged as a response to the need for more inclusive and accessible services for persons with disabilities, including those with visual impairments. Developed in the 1970s by the World Health Organization (WHO), CBR aims to enhance the quality of life for people with disabilities by integrating rehabilitation services into the community, leveraging local resources, and fostering community participation (Mitchell, 1999).
The CBR approach encompasses health, education, livelihood, social, and empowerment components, making it a holistic strategy for disability management. For persons with visual impairment, CBR services often include a range of interventions such as mobility and orientation training, Braille literacy, provision of assistive devices, vocational training, and psychological support. These services are crucial in helping individuals regain independence, improve their self-esteem, and participate fully in community life (Velema & Ebenso, 2016).
Early implementations of CBR focused on physical disabilities and included a variety of interventions tailored to the specific needs of individuals within their community contexts. Over time, the approach evolved to adopt a more holistic view of disability, incorporating not only medical and rehabilitative services but also addressing educational, social, and economic aspects. This evolution was guided by the principles of the United Nations' Convention on the Rights of Persons with Disabilities (CRPD), which emphasizes the importance of accessibility, inclusion, and the participation of persons with disabilities in all aspects of life (UN, 2006).
Throughout the decades, numerous studies and evaluations have documented the positive impact of CBR on individuals with visual impairment. Research has shown that CBR programs can significantly improve the mobility, independence, and social integration of visually impaired individuals (Einarsson et al., 2008). Moreover, these programs have been found to enhance self-esteem and psychological well-being, enabling visually impaired persons to contribute more effectively to their communities. Despite the recognized benefits of CBR, there remains a need for more comprehensive research to evaluate its impact on persons with visual impairment specifically.
Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the impact of community based rehabilitation services on persons with visual impairment.
1.3 Statement of Problems
Investigation revealed that many individuals with visual impairment, particularly in rural and underserved areas, lack access to CBR services. Geographic barriers, inadequate infrastructure, and limited availability of trained personnel often impede the delivery of these essential services (Velema & Ebenso, 2016).
Additionally, effective CBR relies heavily on the active participation and support of the community. However, in many cases, there is insufficient community engagement and awareness, which can hinder the success and sustainability of CBR initiatives. The stigma and discrimination associated with visual impairment further exacerbate this issue, leading to social isolation of affected individuals (Velema & Ebenso, 2016).
Furthermore, many visually impaired individuals face significant economic challenges that limit their ability to participate in CBR programs. These challenges include the costs associated with transportation, assistive devices, and vocational training. Economic constraints can also affect the sustainability of CBR programs themselves, as they often rely on limited funding and resources (Khasnabis et al., 2010). Hence, it is against this backdrop that this study aims to examine the impact of community based rehabilitation services on persons with visual impairment.
1.4 Aim and Objectives of Study
The aim of the study is to evaluate the impact of community based rehabilitation services on persons with visual impairment. In achieving this aim, the following specific objectives were laid out as follows:
- To investigate the level of community engagement in community based rehabilitation initiatives in supporting visually impaired individuals;
- To evaluate the impact of community based rehabilitation services on the functional independence of visually impaired individuals;
- To assess the social outcomes of community based rehabilitation services, such as improvements in social inclusion, reduction in stigma and discrimination, and participation in community activities;
- To evaluate the impact of CBR services on the economic participation and vocational outcomes of persons with visual impairment;
- To analyze the economic barriers faced by visually impaired individuals in accessing CBR services and the financial sustainability of community based rehabilitation programs; and
- To suggest strategies for better integration of CBR programs with other health, educational, and social services to provide holistic support to visually impaired individuals.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- What is the level of community engagement in community based rehabilitation initiatives in supporting visually impaired individuals?
- What is the impact of community based rehabilitation services on the functional independence of visually impaired individuals?
- What are the social outcomes of community based rehabilitation services and participation in community activities?
- What is the impact of CBR services on the economic participation and vocational outcomes of persons with visual impairment?
- What are the economic barriers faced by visually impaired individuals in accessing community based rehabilitation services and the financial sustainability of community based rehabilitation programs?
1.6 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
- H01: Higher levels of community involvement and support are not associated with greater improvements in the social inclusion and psychological well-being of visually impaired individuals.
- H02: CBR service is not a contributing factor to better vocational outcomes and economic participation for visually impaired individuals, helping to alleviate economic barriers and improve their financial stability.
1.7 Significance of Study
The findings of this research study will contribute to the body of knowledge on the effectiveness of CBR programs in improving the lives of individuals with visual impairments. By systematically evaluating various aspects of CBR services, the research provides valuable insights into how these programs can be optimized to better meet the needs of visually impaired persons.
Additionally, the findings from this study can inform policymakers and stakeholders about the benefits and challenges associated with CBR services. Evidence-based recommendations derived from the research can guide the development and implementation of more effective policies and programs that ensure accessible, high-quality rehabilitation services for visually impaired individuals (Velema & Ebenso, 2016).
Furthermore, the research provides a global perspective on the implementation and impact of community based rehabilitation programs, making it relevant for diverse geographical and socio-economic contexts. Also, the research findings can be adapted to different settings, promoting the global advancement of inclusive rehabilitation practices (World Health Organization, 2019).
1.8 Scope of Study
The scope of the research is focused on the impact of community based rehabilitation services on persons with visual impairment using Mbaise Local Government Area of Imo State as a case study.
1.9 Limitations of the Study
During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations include:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
- Initial Cooperation Delay from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.
1.10 Definition of Terms
Visual Impairment:
Visual impairment refers to a significant limitation in vision that cannot be fully corrected with standard glasses, contact lenses, medication, or surgery (WHO, 2019).
Community-Based Rehabilitation (CBR):
CBR is a multi-sectoral strategy that aims to improve the quality of life for people with disabilities by enhancing their participation and inclusion in community life. It integrates health, education, vocational, and social services at the community level, leveraging local resources and fostering community involvement to provide comprehensive rehabilitation support (Khasnabis et al., 2010).
Functional Independence:
Functional independence refers to the ability of an individual to perform daily activities and tasks without requiring assistance from others. For persons with visual impairment, this includes activities such as personal grooming, cooking, mobility, and using assistive technologies to manage everyday tasks (Einarsson et al., 2008).
Social Inclusion:
Social inclusion involves the process of improving the terms of participation in society for people who are disadvantaged on the basis of age, sex, disability, race, ethnicity, and economic status. It ensures that individuals have the opportunity to participate fully in social, economic, and political life, and have access to education, employment, and cultural activities (Mitchell, 1999).
Assistive Devices:
Assistive devices are tools and technologies designed to assist individuals with disabilities in performing functions that might otherwise be difficult or impossible. For persons with visual impairment, these include items such as white canes, screen readers, magnifiers, Braille devices, and electronic navigation aids (World Health Organization, 2019).
Mobility and Orientation Training:
Mobility and orientation training teaches visually impaired individuals how to navigate their environments safely and independently. This training includes techniques for using a white cane, understanding spatial relationships, and developing skills to move confidently in both familiar and unfamiliar settings (Velema & Ebenso, 2016).
