Barriers and Facilitators to Continuity of Care in Rural Geriatric Rehabilitation: A Qualitative Study in Malaysia

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.