Access to stroke rehabilitation services for patients discharged from the Mulago National Referral Hospital Neurology unit, Kampala—Uganda: a mixed-methods study

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Introduction: Rehabilitation is the primary form of therapy for stroke survivors. However, there is a dearth of information regarding access to stroke rehabilitation services following discharge from hospitalization. This study, therefore, examined the level of access and experiences of accessing stroke rehabilitation services following discharge from the Mulago National Referral Hospital (MNRH) Neurology unit, Kampala, Uganda. Methodology: This was a concurrent mixed-methods study. Quantitative data were collected using a study questionnaire from 120 participants and analyzed with STATA version 15.0. A 17-item multidimensional tool was used to measure access, and participants who scored 80% and above were categorized as having high access. Qualitative data were collected through in-depth, face-to-face interviews with six purposively selected participants and analyzed thematically using ATLAS.ti version 25. Results: Of the 120 participants, 55.0% (66/120) were female, 55.8% (67/120) were married, and 44.2% (53/120) had attained a primary level of education. The overall mean age [Standard deviation (SD)] was 58.4 years (±14.6). Only 7.5% of the participants had high access to stroke rehabilitation services. Among the dimensions of access, acceptability scored highest (66.4%), followed by accessibility (24.3%), availability (20.6%), accommodation (15.9%), and affordability (3.7%). Key themes for experiences faced while accessing stroke rehabilitation services included transport challenges, high cost of care, adequacy of rehabilitation resources at hospitals, and organization of stroke rehabilitation services. Conclusion: Access to stroke rehabilitation services after hospital discharge remains suboptimal, with only a small proportion of patients achieving high levels of access. The high cost and limited affordability of rehabilitation care are the predominant barriers to service utilization.

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