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participants were invited by MNUMS and comprised approximately 80 % of the existing Mongolian workforce ( of the 200 original PM & R members listed , many are general physicians , retired and / or were unavailable ). In addition , the visiting team met with independent professionals from nongovernmental organizations ( NGOs ) working in Mongolia ( mainly South Korea and Japan ).
Over a 6-day period , the visiting team ( FK , BA , GA , MG ) assumed a facilitator role in conducting an intensive teaching programme , including a 1-day consensus workshop based on the objectives listed in the GDAP . During the programme , the visiting team summarized the GDAP , and evidence in the field of rehabilitation in various plenary and interactive panel sessions . These included : basic principles of rehabilitation , evidence-based practice and research methods , disability care planning , capacity building , leadership skills development , rehabilitation nursing , symptomatic management ( spasticity , pain , wound care , etc .) and others . The “ host ” hospital lead medical team provided information about the health service and system in Mongolia , including specific challenges faced by PM & R professionals . All information was supplemented with more specific and recorded data during the workshop . During the workshop , participants were divided into 3 panels to ensure that various health professionals were as evenly distributed as possible . Each panel focused specifically on 1 of 3 GDAP objectives . All participants completed a form outlining an overview of the GDAP , with blank corresponding columns for responses . Based on their experiences and issues faced in service delivery , participants in each panel discussed their views and perspectives of various challenges and recorded specific barriers / problems relating to : service provision , attitudes / approaches to PwD , service delivery , education , etc ., in line with the GDAP . Participants also listed potential facilitators for the GDAP objectives . At all times the GDAP was used as a blueprint for discussion and allowed the visiting team to educate the audience ( mainly junior doctors , nurses and some allied health professionals ), many of whom were not familiar with the GDAP document .
In order to gather collective participant opinion , a modified Delphi-consensus method was used . This involved a presentation by 2 speakers from each group , on behalf of their designated panel , followed by a face-to-face large-group discussion in order to brainstorm additional and emerging issues , and to avoid the dominance of some participants that can occur in nominal group consensus methods . At the end , a formal iterative decision-making and consensus process ( with ≥ 80 % of participants agreeing ) was conducted , tabulating potential challenges and facilitators in implementation of the GDAP .
Data collection and analysis
Throughout the workshop , participants submitted their responses in writing for each GDAP objective . They were encouraged to document any emerging issues and present these in the large-group interactive session . The facilitators recorded additional information , comments and recommendations provided by the participants , where possible . All data were collated using the content analytical technique ( 17 ). Two authors ( FA , BA ) scrutinized each response and coded the information using a line-by-line process , which was further clustered into a common suggested “ term ”. When there was no consensus about the possible “ term ”, a final consensus was made through discussion amongst all authors . All authors discussed the final content analysis and reviewed the preliminary version of terms for refinement .
In addition , a desktop literature search ( academic and grey literature using available medical and health science electronic databases ( PubMed , EMBASE , CINAHL , AMED , LILACS and the Cochrane Library ), internet search engines ( such as System for Information on Grey Literature in Europe ; New York Academy of Medicine Grey Literature Collection , National Quality Measures Clearinghouse , and Google Scholar )) and various governmental and non-governmental organizations websites ) was conducted for relevant publications ( including academic articles , reports , related website contents , etc .) for current status on disability and rehabilitation in Mongolia . All relevant information was discussed with participants in this context . Known experts in this field were contacted for further information on disabilityrelated policies and legislation in Mongolia .
RESULTS
Based on the aforementioned multi-pronged approach to obtaining data , the results are summarized in 2 sections below : ( i ) an overview of current disability and PM & R status in Mongolia ; and ( ii ) findings from the interactive and consensus session with regards to GDAP implementation .
Disability status in Mongolia
Disability burden . Despite growing awareness of disability in Mongolia , accurate epidemiological data on disability and disability-related burden is www . medicaljournals . se / jrm