What are structural barriers and facilitators to accessing habilitation or rehabilitation among children with cerebral palsy in low- and middle-income countries? A scoping review

Purpose This scoping review aimed to systematically map the experiences regarding structural barriers and facilitators to accessing habilitation or rehabilitation among children with cerebral palsy (CP) in low- and middle-income countries; and investigate whether experiences vary by social factors. Methods We conducted a scoping review that included qualitative or mixed methods studies (qualitative component) exploring structural barriers or facilitators to accessing habilitation/rehabilitation among children with CP. Structural barriers and facilitators included socioeconomic and political contexts, governance, policies, and cultural/societal values. Paired reviewers screened citations retrieved from databases and charted data, and we conducted a descriptive synthesis. Results We identified 34 relevant studies. Based on one study in a low-income country focused on home-based programs, barriers included restrictive home environments and lack of understanding of CP, while facilitators involved the use of locally available resources. For lower- and upper-middle income countries (33 studies), structural barriers and facilitators to access were related to finances; location, transportation, inaccessibility, and unavailability of services; system infrastructure; lack of knowledge; and perceptions concerning CP. We identified structural barriers as stigma concerning CP in lower-middle income countries, and disruptions during natural emergencies in upper-middle income countries. Conclusions In middle-income countries, children with CP face many structural factors to accessing habilitation or rehabilitation, which intersect with social factors. Research is needed for low-income countries.