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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