Nurses’ insights on challenges and strategies to enhance rehabilitation in rural primary care settings

Introduction: Rehabilitation is a fundamental healthcare component focusing on enhancing and
restoring functional ability and quality of life for individuals experiencing physical, mental, cognitive,
social, and psychological limitations. Rehabilitation helps individuals to maintain or regain independence,
reduces long-term disability and improves community integration. In Rwanda, rehabilitation services
are largely inaccessible in rural primary care (PC) settings, where the majority of persons with disabilities
reside. This study explores nurses’ insights on challenges and strategies to enhance rehabilitation in rural
PC in Burera district, Northern Rwanda.

Methods: The study used a qualitative exploratory design to understand the challenges of rehabilitation
services in PC. The study involved a focus group discussion (FGD) that used a semi-structured interview
guide. Ten health centers’ nurses participated in the FGD conducted at University of Global Health Equity
(UGHE), Butaro campus. The inclusion criteria were a minimum of one year working in outpatient service
at the health center. Additionally, three follow-up individual interviews were conducted to validate
information provided during FGD.

Results: The study identified challenges affecting rehabilitation services delivery and utilization, and
strategies to enhance rehabilitation services at health centers. This included challenges faced by rural
health centers such as limited access to rehabilitation services, inadequate resources and structural and
social barriers. These challenges hinder access and utilization of rehabilitation services at health centers.
Despite the challenges, nurses highlighted strategies to overcome the listed barriers, such as investment
in rehabilitation services, an outreach model, and telerehabilitation, which should increase rehabilitation
services at PC.

Conclusions: Primary healthcare settings in rural Rwanda face multifaceted barriers in providing
rehabilitation services. Strengthening service delivery requires integrating rehabilitation into PC, training
rehabilitation health personnel, improving infrastructure, and adopting innovative solutions like digital
rehabilitation. These efforts will enhance access, reduce disparities, and promote the social inclusion of
persons with disabilities in rural communities.

Keywords: Rehabilitation, Challenges, Strategies, Primary care, Nurses, Disability, Rwanda, Rural
settings, Qualitative study