Coping strategies among a group of community dwelling residents with unilateral lower limb disability in Sri Lanka

Introduction: Coping refers to a type of behavior that protects people from being psychologically harmed by problematic social experience. Lower limb disability causes many difficulties to the affected person because it affects one’s mobility and appearance and is a problematic social experience to the affected individual creating stressful situations and psychological distress. People react by using coping strategies, when facing a stressful situation and they engage in multiple behavioral and cognitive efforts to regain or maintain their well-being.
Adjustment is that the results of using various coping strategies to affect the various stressful aspects of a situation.Coping strategies utilized among lower limb disabled people are diverse. Coping strategies targeting emotions caused by a stressful event (emotion-focused strategies) are found to be associated with psychosocial and functional adjustment following a lower limb disability. Direct efforts to modify the situation (problem-focused strategies) have been linked to a more positive psychological adjustment following lower limb disability.However, there are no reported studies that have assessed the coping strategies among people with lower limb disability in Sri Lanka .
Objective: The aim of the present study is to explore the coping strategies practiced by a group of people with unilateral lower limb disability in Sri Lanka. Method: A sample of 12 persons with lower limb disability who were selected from a serious study to assess the physical disability during a selected population in central Sri Lanka was used as the study participants. The present study useda qualitative research method,in-depth interviews to extractdata on coping strategies related to unilateral limb disability. The in-depth interview guide was supported a conceptual framework produced using the study instrument - Ways of Coping. Rehabilitation with assistive devices is of great benefit to people with limb disabilities, enabling them to steer independent and productive lives. While assistive devices improve the standard of lifetime of persons with lower limb disabilities by facilitating activities of daily living, there also are many barriers to their use. This study aims to explain these barriers among community-dwelling persons with lower limb disabilities in central Sri Lanka .
A community survey was conducted among adults between 18 and 59 years aged , to seek out persons with lower limb disabilities in Kandy Municipal Council area, within the central province of Sri Lanka. This was followed by purposive sampling to pick a sub-sample of 12 individuals with unilateral lower limb disabilities for a qualitative study using in-depth interviews. Unilateral lower limb disabilities were identified employing a clinical examination and World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0). A qualitative thematic content analysis was wont to evaluate the interview text.
Results: All participants used one or more coping strategies. Maximum number of coping strategies used by the study participants was four. Both emotion focused and problem focused coping strategieswere used by all participants (n=12).Among the emotionally focused strategiesare expressing anger (n=5), being alone (n=2) and drawing emotional support from family and relatives (n=8). The problem focused strategies are engaging in their religious activities (n=7), engagement in recreational activities (n=5), engagment in their occupation (n=5), thinking that the lower limb disability condition is due to fate (n=2).Participants described several barriers in using assistive devices, like unaffordable assistive technology like wheelchairs and artificial limbs, unavailability of appropriate assistive technology, difficulties related to repair and maintenance, and problems in accessibility. Limited knowledge of recent technology also restricted their choice of higher devices. Psychological barriers and stigma in using assistive devices directly affected their social lives and day-to-day activities also .
Keywords- Disability; accessibility; assistive technology
Conclusions and recommendations: The study participants have used multiple coping methods to beat their psychological distress and suffering thanks to limb disability. They used both emotion focused coping as well as problem focused coping strategies. Implementation of awareness programmes on coping strategies for the community dwellers with limb disability are needed counting on their gender and age. People with lower limb disabilities face multiple barriers in using assistive devices. These barriers got to be addressed by improving local infrastructure and accessibility facilities, public awareness and funding, and ensuring continuous supply and maintenance services.
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Inoka Eranganie Weerasinghe1 , P. Fonseka2 , S.D. Dharmaratne3

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