Barriers and Facilitators to Continuity of Care in Rural Geriatric Rehabilitation: A Qualitative Study in Malaysia
Main Article Content
Abstract
Background: Older adults in rural areas often face barriers to rehabilitation that affect continuity of care. This study explored barriers to and facilitators of geriatric rehabilitation in rural Malaysia.
Methods: A qualitative phenomenological study involved 30 older adults aged ≥ 60 years who received rehabilitation services between 2018 and 2024, with caregiver proxies participating when necessary. Semi-structured telephone interviews were conducted in Malay, Chinese, or English and were audio-recorded. The recordings were transcribed and translated into English using an automated speech recognition model (OpenAI Whisper). Transcripts were analysed using an AI-assisted thematic analysis framework and classified into eight predefined domains based on sentence-embedding similarity with human review. Segments were manually coded as barriers or facilitators, and scored for sentiment using a rule-based tool (NLTK VADER). Inter-coder reliability was assessed using Cohen’s kappa.
Results: Distance to rehabilitation services and limited transportation were the main barriers to the continuity of care. Financial costs related to travel, treatment, and assistive devices further limited attendance, and some participants reported service constraints. Strong family and community support facilitated rehabilitation engagement. Telehealth was frequently suggested as a means of providing rehabilitation guidance and maintaining continuity of care.
Conclusion: Continuity of geriatric rehabilitation in rural Malaysia is constrained by long travel distances and transportation barriers. Strengthening family support and incorporating simple telehealth approaches may improve continuity of care for older adults in rural communities.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Osborne JL. Physical therapy services for older persons: barriers to access in rural America. Top Geriatr Rehabil. 2008;24(4):337–344. https://doi.org/10.1097/TGR.0b013e31818cd06b
Armstrong JJ, Zhu M, Hirdes JP, Stolee P. Rehabilitation therapies for older clients of the Ontario home care system: regional variation and client-level predictors of service provision. Disabil Rehabil. 2015;37(7):625–631. https://doi.org/10.3109/09638288.2014.935494
Stone R, Harahan MF. Improving the long-term care workforce serving older adults. Health Aff. 2010;29(1):109–115. https://doi.org/10.1377/hlthaff.2009.0554
Biswas P, Lloyd-Sherlock P, Zaman S. Understanding elderly client satisfaction with primary health care in rural Bangladesh. Asian J Gerontol Geriatr. 2006;1:133–140.
Maximos M, Dal Bello-Haas V, Tang A, Stratford P, Kalu M, Virag O, et al. Barriers and facilitators of a community-based, slow-stream rehabilitation, hospital-to-home transition program for older adults: perspectives of a multidisciplinary care team. Can J Aging. 2024;43(1):124–140. https://doi.org/10.1017/S0714980823000442
Rush KL, Singh S, Seaton CL, Burton L, Li E, Jones C, et al. Telehealth use for enhancing the health of rural older adults: a systematic mixed studies review. Gerontologist. 2022;62(10):e564–e577. https://doi.org/10.1093/geront/gnab141
Levasseur M, Routhier S, Clapperton I, Doré C, Gallagher F. Social participation needs of older adults living in a rural regional county municipality: toward reducing situations of isolation and vulnerability. BMC Geriatr. 2020;20(1):456. https://doi.org/10.1186/s12877-020-01849-5
Doraiswamy S, Jithesh A, Mamtani R, Abraham A, Cheema S. Telehealth use in geriatric care during the COVID-19 pandemic—a scoping review and evidence synthesis. Int J Environ Res Public Health. 2021;18(4):1755. https://doi.org/10.3390/ijerph18041755
Totten AM, Womack DM, Eden KB, McDonagh MS, Griffin JC, Grusing S, et al. Telehealth: mapping the evidence for patient outcomes from systematic reviews. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016. Evidence Report/Technology Assessment No. 216.
Almathami HKY, Win KT, Vlahu-Gjorgievska E. Barriers and facilitators that influence telemedicine-based, real-time, online consultation at patients’ homes: systematic literature review. J Med Internet Res. 2020;22(2):e16407. https://doi.org/10.2196/16407
Cahill E, Lewis LM, Barg FK, Bogner H. “You don’t want to burden them”: older adults’ views on family involvement in care. J Fam Nurs. 2009;15(3):295–317. https://doi.org/10.1177/1074840709337247
Marstall KN. Facilitators and barriers to resident physical activity participation in rural long-term care: a facility perspective [dissertation]. Manhattan (KS): Kansas State University; 2024.
Sen K, Ingman S. The elder health information technology framework for geriatric care in rural India: a policy initiative. Commun Netw. 2021;13(1):12–24. https://doi.org/10.4236/cn.2021.131002
Pelcastre-Villafuerte BE, Meneses-Navarro S, Ruelas-González MG, Reyes-Morales H, Amaya-Castellanos A, Taboada A. Aging in rural, indigenous communities: an intercultural and participatory healthcare approach in Mexico. Ethn Health. 2017;22(6):610–630. https://doi.org/10.1080/13557858.2016.1246417
Mukherjee SB. Elderly health care: diverse cultural implication. Asian Ethn. 2019;20:555–570. https://doi.org/10.1080/14631369.2019.1622406
Ismail Z, Mohamed R, Mohd Hassan MH, Wan Su K. Usage of traditional medicines among elderly and the prevalence of prednisolone contamination. Malays J Med Sci. 2005;12(2):50–55.
Chesser AK, Woods NK, Smothers K, Rogers N. Health literacy and older adults: a systematic review. Gerontol Geriatr Med. 2016;2:2333721416630492. https://doi.org/10.1177/2333721416630492
Rasekaba TM, Pereira P, Vinaya Rani G, Johnson R, McKechnie R, Blackberry I. Exploring telehealth readiness in a resource limited setting: digital and health literacy among older people in rural India (DAHLIA). Geriatrics. 2022;7(2):28. https://doi.org/10.3390/geriatrics7020028
Wolf MS, Gazmararian JA, Baker DW. Health literacy and health risk behaviors among older adults. Am J Prev Med. 2007;32(1):19–24. https://doi.org/10.1016/j.amepre.2006.08.024
Weinhold I, Gurtner S. Understanding shortages of physicians in rural areas. Health Policy. 2014;118(2):201–214. https://doi.org/10.1016/j.healthpol.2014.07.018
Wieland D. The effectiveness and costs of comprehensive geriatric evaluation and management. Crit Rev Oncol Hematol. 2003;48(2):227–237. https://doi.org/10.1016/j.critrevonc.2003.06.005
Bendixen RM, Levy CE, Olive ES, Kobb RF, Mann WC. Cost effectiveness of a telerehabilitation program to support chronically ill and disabled elders in their homes. Telemed J E Health. 2009;15(1):31–38. https://doi.org/10.1089/tmj.2008.0046
Menec V, Bell S, Novek S, Minnigaleeva GA, Morales E, Ouma T, et al. Making rural and remote communities more age-friendly: experts’ perspectives on issues, challenges, and priorities. J Aging Soc Policy. 2015;27(2):173–191. https://doi.org/10.1080/08959420.2014.995044