Rethinking Scale-Up of Rehabilitation for Chronic Disease in Low-Resource Settings: Embracing Complexity for...

Area of Science:

• Global Health
• Rehabilitation Medicine
• Health Systems Research

Background:

• Rising global burden of chronic diseases, particularly in low-resourced settings.
• Need to scale effective rehabilitation models to improve functioning and quality of life.
• Existing research often implicitly addresses contextual factors in chronic disease management.

Purpose of the Study:

• To identify and analyze contextual factors influencing rehabilitation interventions for chronic diseases in low-resourced settings.
• To understand the interplay of these factors for successful scale-up.
• To inform the development of more effective and sustainable rehabilitation strategies.

Main Methods:

• Systematic literature review of rehabilitation interventions for chronic disease in low-resourced settings.
• Qualitative analysis using a reflexive and systems thinking lens.
• Iterative analysis of 144 eligible articles to derive contextual factors.

Main Results:

• Identification of 40 distinct contextual factors.
• Categorization of factors into nine key system elements or subsystems.
• Demonstration of the complexity and interconnectedness of factors affecting rehabilitation scale-up.

Conclusions:

• Successful scale-up of rehabilitation in low-resourced settings is complex and multifactorial.
• Nine system elements provide a framework for understanding and addressing contextual challenges.
• Innovative and intersectoral approaches are crucial for meeting rehabilitation needs and improving health outcomes.