Acceptability and feasibility of a faculty development programme for medical and dental academics in Ghana A. B Konadu, E. N.Y Nyarko, K. Asah Opoku, D. Tormeti, A.B Hottor, A. Drovandi, E.A Yawson, S. Hewlett, D.N Banyubala, J. Hart, S. Conen, D.D Siriwardhana, S. Harris, J. Grundy, L. Byrne-Davis BMC Medical Education, 2026 Universal health coverage is more likely to be achieved by competency-based education of health workers than by traditional, time-based learning. Large-scale transitions in pedagogical approaches to such health worker education require effective faculty development. This research aimed to examine the feasibility and acceptability of a UK-based faculty development programme tailored for medical and dental educators within the Ghanaian context. A series of faculty development workshops was provided by a UK-based medical programme, focussing on facilitating the transition from didactic teaching to competence-based medical and dental education. Perceptions of feasibility and acceptability were captured from participants through a post-intervention survey and semi-structured interviews, both utilising the Theoretical Framework of Acceptability, and analysed using thematic analysis. From 27 survey and 15 interview participants representing leaders in medical and dental education in Ghana, the faculty development workshops were positively received, perceived as effectively delivering pedagogical content relevant to medical and dental education in a way that was both engaging and applicable to the local context. Participants felt confident in applying the taught concepts such as clinical placement supervision and clinical reasoning, as well as confident in leading broader uptake of competency-based medical and dental education across educational institutions in Ghana. Conflicting priorities and high workloads for medical and dental educators were perceived as the main barriers to participation and uptake of the workshops nationally. Continuing professional development with contemporary pedagogical approaches is considered essential by educators for training the next generation of health professionals.
Measurement properties of instruments assessing aphasia impact on social participation: a COSMIN systematic review Anuji Patricia De Za, Thushani Umesha Munasinghe, Dhammika Deepani Siriwardhana Aphasiology, 2025 Background<br/>Aphasia is a language disorder that significantly limits a person’s social participation. To date, the suitability of existing patient-reported outcome measures (PROMs) that exclusively assess the impact of aphasia on social participation is unclear.<br/><br/>Aims<br/>This review aims to critically appraise and summarize the evidence of measurement properties of PROMs that exclusively assess the impact of aphasia on social participation using COnsensus‐based Standards for the selection of health Measurement INstruments (COSMIN) criteria and to report the level of involvement of people with aphasia (PWA) during the instrument development process.<br/><br/>Methods<br/>The study was registered in PROSPERO (CRD42022384044). A systematic search was conducted in six electronic databases: MEDLINE, EMBASE, CINAHL Plus, PsycINFO, AMED, and Web of Science Core Collection, spanning from their inception to November 14, 2022. The quality of evidence was evaluated against COSMIN criteria.<br/><br/>Results<br/>Of the 4008 records identified, four studies featuring three instruments (Community Integration Questionnaire (CIQ) adapted for PWA, SOCial ACTivities Checklist (SOCACT), and Stroke Social Network Scale (SSNS)) that exclusively assess aphasia’s impact on social participation were included in the present review. CIQ-adapted reported moderate-quality evidence for sufficient structural validity and high-quality evidence for sufficient internal consistency, test-retest reliability and construct validity. SSNS reported high-quality evidence for sufficient construct validity, including the known-group validity, while SOCACT reported high-quality evidence only for sufficient construct validity. All three instruments have the potential to be recommended for use and were classified as “B”; however, further research is required to assess the already assessed and unassessed measurement properties of these instruments. CIQ-adapted was identified as the best available instrument to assess the social participation of PWA. Also, CIQ-adapted demonstrated a high face validity compared with the other two PROMs. Of all three PROMs, SSNS reported satisfactory patient involvement during instrument development.<br/><br/>Conclusion<br/>Only three PROMs are available in the literature that exclusively assess the impact of aphasia on social participation. None of the PROMs included in the review have been validated for all nine measurement properties. All three PROMs were classified as “B”, and CIQ-adapted was the best available instrument to be used at present. Future studies are warranted to evaluate existing PROMs and to develop new PROMs with sufficient measurement properties.
Telehealth services for children with neuro-developmental disabilities in the Asia-Pacific region: A systematic review Bhagya Devagiri, Akila Dinethra K. Ariyasena, Dhammika Deepani Siriwardhana, Samanmali Sumanasena Child Care Health and Development, 2024 BackgroundIn recent years telehealth became a popular and a rational health service delivery approach, especially amidst multiple challenges posed while providing health care interventions during the COVID‐19 pandemic.AimWe synthesized available evidence on telehealth for managing children with NDDs in the Asia‐Pacific region with the aim of identifying successful methods.MethodologyWe systematically reviewed six electronic databases: MEDLINE, AMED, EMBASE, PsychInfo, Web of Science, and (CINAHL plus) using the keywords and database‐specific subject headings from their inception to 25th August 2021. Review findings were synthesized narratively, and harvest plots were used to demonstrate the effect of interventions. The protocol and reporting the findings of this review adhered to PRISMA 2020 guidelines. PROSPERO registration: CRD 340690.ResultsWe harvested 30,823 records; 17,563 duplicates were removed, and 196 full‐text articles were assessed for eligibility. 16 studies with multiple research designs were included in the review. Eight were from the Pacific region and eight represented Asia. The interventions targeted families and children with a variety of NDDs (autism spectrum disorder, Down syndrome, cleft lip and palate, hearing impairment, cerebral palsy etc.) via telehealth. Telehealth packages consisted of direct and indirect methods of synchronous, asynchronous, and hybrid approaches. All studies used parent‐led intervention strategies. Telehealth reported a positive effect in 7/16 studies while five showed a neutral effect.ConclusionsAccording to published evidence telehealth for children with NDDs is an evolving, evidence‐based service facilitation modality in the Asia‐Pacific region, with only a few published randomized controlled trials. The systematic review shows promising telehealth practices emerging across the region despite the diversity in NDDs studied.
Speech Therapy Interventions for Acquired Apraxia of Speech: An Updated Systematic Review Thushani Umesha Munasinghe, Akila Dinethra K. Ariyasena, Dhammika Deepani Siriwardhana American Journal of Speech Language Pathology, 2023 Purpose: This systematic review aims to summarize and evaluate the available literature on speech and language therapy interventions for acquired apraxia of speech since 2012. Method: A systematic search in six electronic databases was performed from 2013 to 2020. The following primary outcomes were summarized: (a) improvement in targeted behaviors, (b) generalization, and (c) maintenance of outcomes. Moreover, studies were evaluated for the level of evidence and the clinical phase. Results: Of the 3,070 records identified, 27 studies were included in this review. The majority of the studies ( n = 22) used articulatory kinematic approaches followed by intersystemic facilitation/reorganization treatments ( n = 4) and other approaches ( n = 1). According to the classes defined in Clinical Practice Guideline Process Manual (Gronseth et al., 2017), one was Class II, 10 were Class III, 10 were Class III-b (fulfill Class III criteria except for independence of assessors' criterion), and five were Class IV. In terms of clinical phase, one study classified as Phase III, 10 as Phase II, and 15 as Phase I. Conclusions: Among the interventions for apraxia of speech, articulatory kinematic treatments have become prominent over the last 8 years. Focusing on self-administrated therapies, use of technology for therapy administration and development of treatments that focus on apraxia of speech and aphasia simultaneously were identified as new advancements in the apraxia of speech literature. The methodological quality, clinical phase, and level of evidence of the studies have improved within the past 8 years. Large-scale randomized controlled trials for articulatory kinematic approaches and future studies on other treatment approaches are warranted. Supplemental Material: https://doi.org/10.23641/asha.22223785
Stakeholders' perspectives on the provision of vocational training for youth with disabilities in Sri Lanka: Protocol for a mixed-methods study Uvini Tharumali Colonne, Isuru Dharmarathna, Dhammika Deepani Siriwardhana, Tamara Handy, Madhushika Harshani Gamage, Nuwanda Athawuda, Samanmali P Sumanasena BMJ Open, 2022 IntroductionThe quality and the range of vocational training (VT) courses offered to youth with disabilities (YwD) in low-middle-income countries are underexplored. This protocol describes a study designed to gather perceptions of a range of stakeholders related to the quality and relevance of VT programmes conducted by the Department of Social Services in Sri Lanka. The purpose of this study is to communicate with authorities the ways in which they can improve their services by paying close attention to the needs and recommendations of all stakeholders.Methods and analysisA parallel mixed-methods study will be conducted at eight vocational training institutes (VTIs). A survey will be conducted with five participant groups; YwD presently enrolled in VTIs (n=358) and their caregivers (n=358), YwD who completed the VT (n=45) and their caregivers (n=45) and educators at VTIs (n=47). The qualitative component includes semi-structured interviews and focus group discussions. The three groups of participants include: educators, caregivers of potential YwD for future VT (6–10 per group) and key informants from state, corporate and non-governmental sectors (a total of 20). Quantitative and qualitative data will be analysed using descriptive and inferential statistics and cross-thematic analysis, respectively.Ethics and disseminationThis study received ethical clearance from the Ethics Review Committee, Faculty of Medicine, University of Kelaniya (Ref. No: P/15/02/2021). All data collection processes will abide by health and safety measures required by the national government. Written informed consent will be obtained from all participants. Results from this research will be disseminated, to local stakeholders and participants, via local and international conferences and publications in peer-reviewed journals.
Association between frailty and disability among rural community-dwelling older adults in Sri Lanka: A cross-sectional study Dhammika Deepani Siriwardhana, Manuj Chrishantha Weerasinghe, Greta Rait, Shaun Scholes, Kate R Walters BMJ Open, 2020 ObjectiveWe examined the association between frailty and disability in rural community-dwelling older adults in Kegalle district of Sri Lanka.DesignA population-based cross-sectional study.ParticipantsA total of 746 community-dwelling adults aged ≥60 years.Primary and secondary outcome measuresFrailty was assessed using the Fried phenotype. Disability was operationalised in terms of having one or more activity limitation/s in instrumental activities of daily living (IADL) and basic activities of daily living (BADL).ResultsThe median age of the sample was (median 68; IQR 64–75) years and 56.7% were female. 15.2% were frail and 48.5% were prefrail. The prevalence of ≥1 IADL limitations was high, 84.4% among frail adults. 38.7% of frail adults reported ≥1 BADL limitations. Over half of frail older adults (58.3%) reported both ≥1 physical and cognitive IADL limitations. Being frail decreased the odds of having no IADL limitations, and was associated with a higher count of IADL limitations. No significant association was found between prefrailty and number of IADL limitations.ConclusionsThe prevalence of ≥1 IADL limitations was high among rural community-dwelling frail older adults. Findings imply the greater support and care required for rural Sri Lankan frail older adults to live independently in the community.
Socioeconomic inequality and determinants of postnatal home visits made by public health midwives: An analysis of the Sri Lanka Demographic and Health Survey Dhammika Deepani Siriwardhana, Arunasalam Pathmeswaran, Ananda Rajitha Wickremasinghe Plos One, 2019 Introduction The impact of socioeconomic inequalities on health outcomes and service delivery is increasingly researched globally. This study assessed the overall and sector-wise socioeconomic inequality in postnatal home visits made by Public Health Midwives (PHMs) in Sri Lanka and decomposed the observed socioeconomic inequality into potential determinants. Methods Data from the Sri Lanka Demographic and Health Survey (SLDHS) 2006–07 were used. Data were collected from ever-married women who gave birth to their last child in 2001 or later (up to 2007). Whether the PHM visited the home to provide postnatal care within one month of the delivery was the health outcome of interest. Sri Lanka is divided into three sectors (areas) as urban, rural, and estate (plantation) based on the geographical location and the availability of infrastructure facilities. Concentration indices were calculated and concentration curves were plotted to quantify the overall and sector-wise socioeconomic inequality. Decomposition analysis using probit regression was performed to estimate the contribution of potential determinants to the observed socioeconomic inequality. Results Overall, 83.0% of women were visited by a PHM within one month of the delivery. The highest number of home visits was reported in the rural sector (84.5%) and lowest was reported from the estate sector (72.4%). A pro-poor, pro-rich, and no inequality were observed across urban, rural, and estate sectors respectively. Wealth had a small contribution to the estimated inequality. Province of residence and the education level of women were the main determinants of the observed socioeconomic inequality. Conclusion Addressing the socioeconomic inequality of postnatal home visits made by PHMs should not be seen as a health system issue alone. The associated social determinants of health should be addressed through a multi-sectoral approach encompassing the principles of primary health care.
Prevalence of frailty in rural community-dwelling older adults in Kegalle district of Sri Lanka: A population-based cross-sectional study Dhammika Deepani Siriwardhana, Manuj Chrishantha Weerasinghe, Greta Rait, Milena Falcaro, Shaun Scholes, Kate R Walters BMJ Open, 2019 ObjectiveOur main objective was to describe the prevalence and associated sociodemographic factors of frailty and pre-frailty in rural community-dwelling older adults in Kegalle district of Sri Lanka.DesignCommunity-based cross-sectional study.SettingThe study was conducted in rural areas of Kegalle district in Sri Lanka.ParticipantsA total of 746 community-dwelling older adults aged ≥60 years were included in the study.ResultsThe prevalence of frailty and pre-frailty in rural Kegalle district was 15.2% (95% CI 12.3% to 18.6%) and 48.5% (95% CI 43.8% to 53.2%), respectively. We found a strong association between age and both frailty and pre-frailty. There were strong associations between longest-held occupation and frailty and education level and pre-frailty.ConclusionsThe prevalence of frailty in this rural Sri Lankan older population was high compared with high-income and upper middle-income countries. The profile of health and social care services in Sri Lanka needs to address frailty and its consequences.
Cross-cultural adaptation and psychometric evaluation of the Sinhala version of lawton instrumental activities of daily living scale Dhammika Deepani Siriwardhana, Kate Walters, Greta Rait, Juan Carlos Bazo-Alvarez, Manuj Chrishantha Weerasinghe Plos One, 2018 Introduction Instrumental activities of daily living (IADL) are cognitively complex activities related to independent living in the community. Robust IADL scales are needed, however the psychometric properties of instruments have been little evaluated. There is no validated instrument for Sri Lankan older populations. Sri Lanka has the highest proportion of older people in South Asia with rapid population ageing. Therefore, it is essential to have standard instruments to assess activity limitations. We aimed to cross-culturally adapt the original Lawton Instrumental Activities of Daily Living Scale from English to Sinhala and evaluate the psychometric properties of the Sinhala version. Methods Cross-cultural adaptation of the instrument was performed. The instrument was validated in a sample of 702 community-dwelling older adults aged 60 years and above in Sri Lanka. Reliability (internal consistency and inter-rater reliability) was assessed. Construct validity of the scale was evaluated by performing exploratory and confirmatory factor analysis and testing convergent and divergent validity. Results The Lawton IADL scale was successfully adapted to Sri Lankan context. Internal consistency of the scale was very high (Cronbach’s alpha = 0.91). Very good inter-rater reliability was observed with very good agreement for all items. Inter-class correlations for overall IADL score ranged from 0.57 to 0.91. Results of the exploratory and confirmatory factor analyses supported the unidimensionality of the scale. Goodness of fit indices in confirmatory factor analysis were in acceptable range (CFI = 0.98, SRMR = 0.06, NNFI = 0.97). Strength of associations were significant and in the expected direction. Results of the known group validity were also significant, confirming the convergent and divergent validity. Conclusion The Lawton IADL scale was successfully translated and culturally adapted to Sinhala language. The Sinhala version demonstrated excellent reliability and construct validity. Given good psychometric properties, this scale would be recommended for use in future research.
