The research, carried out in the Ablekuma South District of the Greater Accra Metropolis during the first and last quarters of 2020, forms part of a broader effort funded by the Alliance for Health Policy and Systems Research through the RAISE project to adapt home visit guidelines for Ghana. Researchers from the University of Ghana and partner institutions conducted five focus group discussions with 36 participants, including community health nurses, community health officers and programme managers, alongside three stakeholder engagement meetings involving 46 people such as district health administrators, community volunteers, faith healers and herbal practitioners. All sessions were audio-recorded with consent, transcribed, and independently analysed by three qualitative scientists using the Braun and Clarke thematic approach, with findings validated back to stakeholders.

The results, published in Health Research Policy and Systems, paint a stark picture of physical deprivation. Nurses reported lacking the most basic tools of their trade: blood pressure apparatus, thermometers, weighing scales, cotton wool and first aid kits with essential medications. One nurse described her visiting bag as effectively empty, asking how she could responsibly administer family planning without first checking a client’s blood pressure. Protective clothing was equally absent, with no raincoats, umbrellas or footwear provided for staff who must walk long distances through hilly, rocky and densely populated terrain. When asked who should supply these resources, participants pointed to the government through the district health directorate, while noting that philanthropic support was irregular and that some nurses quietly paid out of their own pockets to fund essential care for clients.

Transportation emerged as a compounding physical barrier. Nurses are assigned large geographical catchment areas to cover repeatedly for months or years, and in rural postings motorbikes, training and fuel stipends are sometimes provided. In Greater Accra, however, heavy traffic and safety concerns mean motorbikes are withheld from community health nurses, who are predominantly women, and vehicles are often reassigned to male staff for non-visit duties. Participants who had worked in other regions described outreach vehicles and transport allowances there, contrasting sharply with the Accra facilities where nothing at all was provided. The inconsistency, they said, is poorly documented and leaves urban nurses dependent on unreliable stipends or their own feet.

Beyond logistics, the study identified a cluster of psychological challenges rooted in mistrust and fear. Clients seeking to avoid follow-up visits provide false addresses, unreachable phone numbers, or directions to locations that do not exist, such as a brown gate just around a corner that never materialises. Some families simply refuse entry, particularly when a newborn is in the house and grandparents wish to continue traditional practices that a nurse would object to. More alarmingly, nurses reported verbal and physical attacks from relatives of clients, stray dog attacks at gated homes, and even sexual assaults on unarmed young female staff by men in the communities. One nurse recounted how a husband threatened to organise boys to beat visiting staff; the visits stopped, and the woman he sought to shield from care later died.

Role conflict adds a professional dimension to these psychological strains. Community health nurses who care for pregnant women at home are expected to record their findings and medications, such as malaria prophylaxis, in antenatal booklets that midwives consider their own record space. Midwives queried nurses who wrote in these books, and nurses eventually stopped, creating fragmented documentation for women receiving care from both cadres. Participants argued that clearer job descriptions and defined boundaries of practice are needed so that midwives understand visiting nurses are supporting, not supplanting, their work.

Sociocultural interferences form the third major barrier. Many community members attribute illness to spiritual causes and exhaust herbal or faith-based remedies before considering medical treatment, with traditional healers referring patients to hospitals only after indigenous treatments fail. Sacred and festive days render entire communities inaccessible on scheduled days, forcing nurses to build their itineraries around fishing days and market days. Religious objections to modern family planning lead women to default on antenatal care and deliver at home without skilled supervision. Traditional newborn practices, including applying hot stones, saliva, ground chalk, gauze and towels to the umbilical cord, and keeping infants hidden until an out-dooring ceremony, directly restrict nurses’ access to the most vulnerable patients. Patriarchal household structures compound this, since male heads of family must often grant permission before health information can reach women and girls.

The solutions proposed by participants are strikingly practical. They called for well-stocked visiting bags, vaccine supplies, transport funding and expanded CHPS coverage, with some suggesting more male nurses on visiting teams so male clients can speak comfortably. For safety, they recommended community maps, walking boots, umbrellas and raincoats, a companion model pairing nurses with trusted community volunteers, walking in groups where no companion is available, and even defensive equipment such as pepper spray or tasers, possibly issued through police partnerships and returned at the end of each day. In-service training and, crucially, a dedicated Ghanaian home visit practice guideline specifying scope, boundaries, referral pathways, service set-up, logistics and human and financial resources were described as the foundation for everything else. The researchers note that the existing Disease Prevention Life Course Approach Model underpinning CHPS contains no clear-cut guidance on home visit activities, leaving staff uncertain and the practice difficult to evaluate.

The study’s authors argue that guidelines developed in high-income countries such as the United States and Canada, while useful, do not address the layered community, family and household gatekeepers, the absent addressing systems, the security realities and the cultural nuances of Ghana. Formative research to tailor training, public education campaigns, male Community Health Ambassadors recruited through men’s fellowship meetings, mixed-gender visiting teams, culturally sensitive uniforms and dedicated communication lines to the police are among the measures they propose. They caution that the findings, drawn from purposively selected participants in one district and vulnerable to recall and participation bias, cannot be generalised, but they believe the lessons apply broadly across low- and middle-income countries in Africa and Asia where patriarchal structures, poor road networks and weak addressing systems similarly constrain community health work. With dedicated, culturally grounded guidelines, they conclude, home visiting in Ghana could finally be prepared, protected and accountable enough to deliver on its century-old promise.

Subject of Research: Barriers to and solutions for nurse-led home visit practice in Ghana

Article Title: Challenges of home visit practice and perceived solutions for improvement in Ghanaian context: perspectives of healthcare professional and community informants

Article References: Ohene, L. A., Adjorlolo, S., Chandi, M. G., Aryeetey, C., Ansah- Ofei, A. M., Aikins, M., & Aziato, L. (2026). Challenges of home visit practice and perceived solutions for improvement in Ghanaian context: perspectives of healthcare professional and community informants. Health Research Policy and Systems, 24(S1), Article 72. https://doi.org/10.1186/s12961-026-01461-w

Image Credits: AI Generated

DOI: 10.1186/s12961-026-01461-w

Keywords: home visits, community health nurses, Ghana, primary healthcare, CHPS, practice guidelines, universal health coverage, sociocultural barriers, nurse safety, qualitative research, Challenges, home

Researchers led by Rina Juel Kaptain of University College of Northern Denmark and the Parker Institute, together with colleagues from the University of Southern Denmark and Greve Municipality, surveyed occupational therapists involved in assistive technology service delivery across Danish municipal units. The target population comprised the 605 occupational therapists registered as working in this system in 2021. Using snowball sampling through professional networks and municipal department heads, the team collected questionnaire data over three weeks in April 2022. In total, 224 therapists responded and 206 completed the survey, meaning roughly one-third of the entire national workforce in assistive technology provision took part. Participants represented all five regions of Denmark and spanned wide ranges of age, professional experience and tenure in their current positions.

The findings paint a picture of an assessment practice built largely on personal judgement rather than standardised procedure. Nearly all participants, 92 percent, combined telephone interviews and home visits to gather information. Fifty-nine percent said they often used telephone interviews, while 74 percent reported conducting home visits. During those visits, 95 percent combined interviewing with direct observation of the client in their own environment, though only a quarter used questionnaires as an information-gathering method. The choice of approach often depended on the type of device requested: as one participant explained, larger cases always warranted a home visit, while smaller aids such as toilet aids, walkers or grippers were frequently handled in a single phone call.

More striking still was the near-absence of formal assessment instruments. Almost two-thirds of participants, 61.2 percent, reported not using standardised assessment tools at all. Among those who did, many relied on locally created questionnaires or checklists, or borrowed fragments of established instruments. Several therapists described drawing loosely on tools such as the Assessment of Motor and Process Skills, the ADL Taxonomy, the Canadian Occupational Performance Measure and the International Classification of Functioning, Disability and Health, but rarely in their entirety. Only 4 percent reported using a standardised tool in full, 17 percent used parts of a single tool, and 38 percent mixed parts of different tools together. Roughly 78 percent said their workplace had made no decisions about which tools should be used, and almost 80 percent reported having no guidelines about tool selection at all.

These results matter because the assessment step forms the foundation of the entire service delivery process. The European assistive technology service delivery model, developed through the HEART study of the European Commission and later refined by the AAATE and EASTIN consortium in 2012, describes seven steps: initiative, assessment, selection of the assistive solution, selection of the equipment, authorisation, implementation, and management and follow-up. Assessment occupies the second step and, according to the model’s recommendations, should evaluate the client’s individual needs using standardised procedures while keeping the client’s perspective at the centre. The Danish guidelines under the Social Service Law similarly emphasise a comprehensive, concrete and individual assessment performed in close collaboration with the client, who is regarded as best placed to express their own needs.

Previous research underscores why this matters. Systematic reviews show that satisfaction with and usefulness of assistive technology increase when professionals understand clients’ needs, expectations and preferences, and involve them in identifying personal goals. Studies from Bangladesh and elsewhere demonstrate that user involvement in service delivery predicts better outcomes of assistive technology use. Conversely, research on occupational therapy evaluation shows that when assessment relies solely on self-report through unstructured interviews without observation, important information about a client’s actual daily activity performance goes missing. A recent scoping review of the WHO European region likewise identified inadequate assessment procedures as a barrier to accessing high-quality assistive technology services.

Paradoxically, despite the variability and lack of standardisation, the surveyed therapists were largely content with their practice. Nearly three-quarters felt they had the opportunity to perform a relevant assessment, and 89 percent reported being satisfied or very satisfied with how they conducted it. The authors suggest this contentment may reflect the fact that assistive technology service delivery, unlike rehabilitation practice, lacks a strong tradition of working according to occupational therapy process models. Comments from participants revealed an awareness of constraints: some cited insufficient time and resources, noting that quantity of applications often took priority over quality of professional work, while others attributed their assessment ability primarily to accumulated experience, with one noting that forty years of practice helped.

The researchers argue that the absence of workplace guidelines effectively leaves each individual therapist’s discretionary judgement to determine how every client is assessed. They point to occupational therapy frameworks such as the Occupational Therapy Intervention Process Model and the Canadian Practice Process Framework, both of which include structured assessment phases focused on understanding the relationship between a client’s occupations and their contexts. A related Danish study found that when therapists used theoretical frameworks and structured instruments, they felt more professionally competent in the service delivery process. Employing such models as the backbone of standardised procedures could, the authors suggest, enhance equality in service quality and reduce the impact of varying experience levels across therapists.

The study does carry methodological caveats. Snowball sampling risks bias, and while the questionnaire was pilot tested to establish face validity, additional pilots with therapists from more diverse municipalities would have strengthened it. Even so, the broad national representation lends weight to the conclusion. The authors call for a standard minimum guideline for comprehensive assessment within the Danish assistive technology service delivery system, and propose renewed international work toward a standardised, interdisciplinary framework for the full service delivery process, one that keeps the user central and addresses satisfaction and abandonment of devices. Future research, they suggest, should examine whether assessment practices differ by device type, how other professions conduct such assessments, and whether integrating occupational therapy process models improves the Danish system overall.

For the millions of people worldwide who depend on assistive technology to manage daily life after illness, injury or age-related decline, the study is a reminder that the quality of a wheelchair or hearing aid is only as good as the assessment behind it. Denmark’s experience suggests that even in well-resourced welfare systems, the pathway from need to device can rest on practices that are neither uniform nor evidence-informed, and that closing this gap may be one of the most consequential improvements available in assistive technology provision.

Subject of Research: How Danish occupational therapists perform comprehensive assessments in the assistive technology service delivery process

Article Title: Comprehensive assessment as part of the assistive technology service delivery process

Article References: Kaptain, R. J., Riisager, M., Juul, C., Olsen, M. R., & Wæhrens, E. E. (2025). Comprehensive assessment as part of the assistive technology service delivery process. Scandinavian Journal of Occupational Therapy, 32(1), Article 2451287. https://doi.org/10.1080/11038128.2025.2451287

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2451287

Keywords: assistive technology, occupational therapy, assessment, service delivery, Denmark, standardised assessment tools, home visits, client-centred practice, survey, guidelines, rehabilitation, ADL