Barriers and facilitators experienced by people with neurological disabilities: A South African health systems perspective

Abstract

Background: Globally, there has been an increase in neurological disorders such as stroke and spinal cord impairments, which often result in permanent disability and require long-term care. However, there is limited evidence on factors influencing the continued care journey for people with neurological disabilities. Aim: This study aimed to explore the barriers and facilitators experienced by people with neurological disabilities throughout their care journey. Setting: This study was conducted in a specialised rehabilitation hospital. Methods: An explorative qualitative design was used. Semi-structured interviews were conducted with 26 patients with neurological disabilities and 15 health professionals. MAXQDA (2024) software was utilised for thematic data analysis. Results: Key environmental barriers influencing the care journey included limited or delayed access to care, inaccessible infrastructure and transport, a lack of health resources, financial and employment challenges, and poor support and attitudes. Personal factors were identified as the impact of limitations or restrictions on physical function, the patient's own beliefs, and self-motivation. Conclusion: People with neurological disabilities experience numerous barriers that suggest gaps in the health system. Throughout the care journey, there is a need to improve health system responsiveness, service accessibility, treatment quality, and health system governance. Contribution: Specialised health services and system improvements are recommended for people with neurological disabilities, particularly in rehabilitation care and community integration.