Physiotherapists' and occupational therapists' perspectives on challenges and opportunities for equitable stroke rehabilitation in northeastern Tanzania - a qualitative study.

Abstract

Low- and middle-income countries worldwide, including Africa, are facing rising incidences of stroke and increased need for stroke rehabilitation. This study aimed to explore rehabilitation professionals' perceived challenges and opportunities for achieving equitable stroke rehabilitation in northeastern Tanzania. In this descriptive qualitative study, semi-structured individual interviews were conducted with eight physiotherapists and four occupational therapists. An interview guide covering the theme of stroke rehabilitation was used. The face-to-face interviews were audio recorded, transcribed verbatim, and analysed using inductive qualitative content analysis. The overarching theme Raising awareness of rehabilitation while overcoming systemic barriers for stroke rehabilitation was based on five categories: 1) Influenced by the cultural context, 2) Awareness of rehabilitation opportunities, 3) Economic and social resources, 4) Inequitable accessibility to healthcare, and 5) Lack of coordination and consensus in healthcare structure. The therapists expressed multidimensional needs to facilitate rehabilitation after stroke. Main challenges included systemic barriers within the environment, resources, and healthcare structure. Possible assets included advocacy for rehabilitation, community solidarity, and creative use of self-made aids and adaptations. Furthermore, the development of a culturally adapted national guideline and expanding the National Health Insurance Fund could facilitate more equitable care and rehabilitation services.