Barriers and enablers to help seeking, treatment adherence and recovery among community-based drug rehabilitation clients in the Philippines

BackgroundIrrespective of the severity, survival of a stroke has become commonplace, but many experience long-term physical, cognitive, and emotional difficulties, with walking difficulties being a frequent challenge. The community-based model of gait training is an innovative and holistic approach to neurorehabilitation that focuses on restoring mobility and enhancing the overall quality of life of stroke survivors.AimsTo assess the impact of community-based stroke rehabilitation programs from existing literatures.ObjectivesTo identify community-based stroke rehabilitation programs that are effective in improving function in stroke survivors.MethodsWe conducted a scoping review of peer-reviewed articles to understand the impact of the community-based rehabilitation model of mobility training after stroke. We searched five different databases: PsycINFO, PubMed, CINAHL complete, Embase, and SCOPUS using topic-specific keywords. Only studies published in the English language from 2013 to 2023 were included.ResultsThirty-five articles met the inclusion criteria. Mobility training using either a treadmill or overground surfaces improved mobility. Orthotics use improved gait and balance among stroke survivors. Adapted video games for rehabilitation improved gait speed, balance, and mobility while the use of transcutaneous electrical nerve stimulation (TENS) aided functional recovery. The use of music or sound incorporated with exercises improved mobility, gait speed, and balance. Engaging in group exercises improved walking capacity, balance, walking speed, cardiovascular function, and community integration.ConclusionSome community-based rehabilitation programs are effective in improving the physical and social recovery of stroke survivors. This concept can be considered when planning a recovery program for stroke survivors who do not have the ability to access a hospital rehabilitation setting.

Purpose: To examine community perspectives regarding the strengths, weaknesses, opportunities, and threats of a community-based rehabilitation (CBR) program in Toledo District, Belize.Method: A participatory approach was implemented using the CBR Matrix as a conceptual framework. Semi-structured interviews were conducted with CBR community partners and program participants living in Toledo District. Respondents were recruited until thematic saturation was achieved (i.e., no new themes were identified from subsequent interviews). Interviews were recorded and transcribed verbatim. Recurring themes were identified using thematic content analysis.Results: Eight CBR community partners and 11 program participants completed interviews. Key strengths of the program included engaging CBR program participants as partners in the decision-making process and raising disability awareness. Key weaknesses of the program included lack of a vocational training program and lack of a systematic approach to identify people with disabilities (PWD) or risk factors for disease and disability.Conclusions: This participatory evaluation provided PWD, their families, and the community the opportunity to express their needs and priorities regarding CBR. Key recommendations included: (1) developing vocational training programs for PWD; (2) expanding collaborations with craftspeople and other community partners throughout Toledo District; (3) continuing the disability awareness program in schools and the broader community; and (4) strengthening community outreach and data collection.Implications for RehabilitationPersons with disabilities, their families, and community partners should play an active role in the development, implementation, and evaluation of CBR programs to ensure program goals align with community priorities.The CBR evaluation process should strive to include diverse perspectives that represent the most marginalized populations (e.g., individuals with significant disabilities living in geographically remote areas).The CBR matrix can provide a comprehensive and flexible framework with which to examine community perspectives regarding the strengths, weaknesses, opportunities, and threats of CBR programs.

Since the promulgation and implementation of a new anti-drug law in 2008, the Chinese central government has encouraged local governments to carry out community-based drug rehabilitation programmes. This study explores the association between community-based drug rehabilitation programmes and drug users' physical and mental health. This study collected data between October 2018 and February 2019 from a community-based rehabilitation programme in a community in Foshan Municipality in Guangdong Province of China. A total of 162 drug users participating in a community-based drug rehabilitation program were selected to complete a self-administered and anonymous questionnaire. A cover letter interpreting the purpose of the study and a self-administered questionnaire was provided to the drug users. Ethics approval for this study was obtained from the Academic Committee of School of Public Administration, JiNan University, Guangzhou, China. All participants gave verbal informed consent. Four multiple linear regression models were used to explain social services that influence drug users' physical and mental health. The findings show that the number of service items provided by the social service organization was significantly associated with physical and mental health among drug users. Particularly, the employment assistance service influenced the drug user's physical and mental health status significantly.

PurposeQualitative participatory methods are needed to measure the effectiveness of the community-based rehabilitation (CBR) program in Namibia. The study explored the experiences of CBR volunteers in evaluating CBR program in Namibia through the use of photovoice. Further the study assessed the strengths and limitations of utilizing photovoice method as an assessment tool for CBR evaluation.Design/methodology/approachThe study employed a qualitative, explorative, descriptive and contextual design. Data was collected through the photovoice method. Two CBR sites and 16 participants who were CBR volunteers were purposively selected. Data was collected and analysis was conducted simultaneously utilizing the photovoice method and themes were determined using WHO CBR matrix.FindingsVarious experiences were elicited regarding participants' experiences in line with the five components of the CBR matrix. Most experiences were reported regarding the health component, and the education component had the least experiences reported. Methodological strength and weaknesses as well as implications for practice are revealed. Further research can explore the benefits of combining photovoice with other data collection methods.Research limitations/implicationsThe use of purposive sampling in selecting both CBR sites and participants limited wider representation of CBR program sites and persons with all disabilities in Namibia, respectively.Originality/valueSustainability of CBR programs depends on community ownership, empowerment and government funding. Photovoice is participatory and hence gives community ownership and empowerment. Evidence from photovoice can enable persons with disabilities to formulate action plans that can advocate their concerns with policymakers and justify more funding for CBR programs.

Introduction: There has not been agreement within the Health Care Services regarding the role of Community Based Rehabilitation (CBR) workers. The training of CBR workers continues although the process was not widely supported and the CBR worker’s function has not been clarified yet CBR programmes are included in the training of students.Aim: The aim is to identify and describe the role of the CBR workers within the Odi District Health Service (DHS) and determine whether they are fulfilling the rehabilitation arid development functions envisaged by the WHO model of CBR programmes.Methodology: Qualitative and quantitative research methods were used. These included a questionnaire; observations of the daily tasks of the CBR workers and interviews with members of the District Health Service (DHS) of the Odi district, clients and CBR workers. Open and axial coding were used in data analyses. Data from the different sources were triangulated to ensure trustworthiness.Results: The skills performed by CBR workers have produced a change in the lifestyle of the disabled people and the initiated projects are benefiting the families of the disabled people within the CBR programme as well as their community. There seems to be a break down of communication between the District Health Manager (DHM) and the supervisor of the CBR workers. A lack of communication within the DHS affects the functions of the CBR workers.Conclusion: It is concluded that, although the tasks of the CBR workers within the Odi DHS are not supported, they produce a positive impact on the quality of life of the disabled within the CBR programme. The CBR workers’ contribution towards community development, although on a small scale, proves that they operate within the World Health Organization’s (WHO) guidelines for CBR.

Purpose: The survey aimed to identify common strengths and weaknesses regarding the characteristics, management and implementation of Community-Based Rehabilitation (CBR) training in the undergraduate curriculum of Schools of Physical Therapy in the Philippines, and make recommendations for improvement. Method: A survey was conducted with the academic heads of CBR departments in 10 Physical Therapy schools. The institutions were selected through cluster sampling according to regional location. Nine of these were private institutions. Data was collected through a 24-item self-assessment survey distributed to the heads of the participating colleges /departments. Results: A number of strengths and weaknesses were identified. The strengths were: all schools had a 1 to 2-month clinical CBR course integrated into their undergraduate curriculum; CBR courses were supported by a course syllabus, learning outcomes, student assessment and clinical training manual; 80% of institutions had implementing policies and guidelines governing management of the CBR programme(s); at least one physiotherapist was involved in the management of the CBR programme(s); and, CBR activities were delivered in coordination with key stakeholders management, with emphasis on delivery of physical therapy services, disability prevention, health education, participation of persons with disabilities and community awareness. The weaknesses were: no head/programme coordinator for 30% of CBR programmes; 40% did not have clinical coordinators as designated management positions in the CBR programme; only 50% of academic staff received formal CBR training, of which 80% was provided through CBR summits and professional interaction with other physical therapists; and, only 50% of schools adopted a multidisciplinary approach to service delivery which was focused on the Health domain of the CBR Matrix. Conclusion: The CBR component of the undergraduate physical therapy curriculum in the Philippines can be improved. A shift in the teaching to transdisciplinary care and inter-professional learning is recommended. Regular review of the CBR indicators should be done by the schools, including the key stakeholders. Challenges for CBR implementation were recruitment of community volunteers as CBR workers, availability of indigenous resources and finances to support CBR activities, and family participation in the rehabilitation of a relative with a disability. Each school should determine whether current human resources and training are adequate. Schools must be encouraged to jointly identify common problems in CBR education and share solutions.

PROTOCOL: Community‐Based Rehabilitation for People with Disabilities in Low‐ and Middle‐Income Countries

Background: 
\nCommunity Based Rehabilitation (CBR) is the strategy promoted by the World Health Organization (WHO) and other United Nations (UN) agencies as an effective way to improve the lives and wellbeing of people with disabilities in underserved regions. During the last decade CBR has undergone major reconceptualization, and is now a multi-sectorial approach, as reflected in the new CBR guidelines. Evaluation of Community-based Rehabilitation (CBR) is considered important for developing good practice. However, evaluations remain scarce and as a consequence very little is known about how CBR benefits persons with disabilities and their families. Consensus is lacking about appropriate evaluation methods in CBR.
\nLeading international frameworks such as the United Nations Convention on the Rights of Persons with Disabilities (CRPD) and the WHO CBR Guidelines have participation as one of the core principles in their human rights based approach to disability, including participation in programme evaluation. The WHO CBR Guidelines strongly recommend the application of participatory evaluation (PE) approaches in CBR. However, while there are many models of PE in mainstream development, it is unclear which may be appropriate for use in CBR.
\nThe aim of this research is to identify, field test, adapt and assess an existing model of Participatory Evaluation (PE) in a real world environment. This thesis, rather than researching the impact of CBR on people with disabilities, focuses on the evaluation process itself and the variables that affect changes in stakeholders thinking and behavior as a result of engagement in the evaluation.
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\nMethodology
\nThere were two research components:
\n1. Selection of PE model to be adapted to CBR:
\nThree steps were taken to provide background for an expert group to select one model for field-testing: 
\nAn online survey of current evaluation capacities and practices within CBR programmes internationally; 
\nA systematic review of PE models used in international development; 
\nA Delphi study with CBR experts to derive criteria for good PE models for CBR.
\nThe expert group used the research findings and selected Outcome Mapping (OM) as PE model to be implemented and field-tested in a CBR programme in Jamaica.
\n2. Field testing of the PE model in a Jamaican CBR programme: This research component consisted of three main elements:
\nThe implementation and adaptation of PE (OM) in a Jamaican CBR Programme;
\nInterviews and focus groups collecting narratives about the evaluation process from stakeholders were undertaken to explore the usability of the adapted PE model in this programme. Changes in “process use”, i.e. how the stakeholders in the evaluation learned from and acted upon their involvement in the PE processes, were explored; 
\nThe participatory development of a framework that participants felt could guide PE in CBR, one that can be locally adapted to different situations.
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\nConclusion: 
\nThe evaluation participants felt there were significant limitations of the OM approach in their setting and therefore proposed a substantially modified model. They favored a more fluid PE framework, which was flexible, adaptive and iterative, rather than a rigid approach, and one that focused on creating a safe space for sharing, learning and taking action. The thesis concludes with a call for more critical and bottom-up approaches of evaluation that move away from control-oriented approaches towards a more experimental and adaptive problem and process-orientated mindset of evaluative thinking.

Background:There is a need for accessible and affordable rehabilitation services in low-resource settings (low- and middle-income countries) to support the increasing number of survivors of stroke.Aims:To synthesize existing literature on the delivery of community-based stroke rehabilitation programs in low-resource settings.Summary of review:We followed the PRISMA Scoping Review guidelines. Seven databases (including MEDLINE, PsycINFO, and CINAHL) were searched to identify relevant articles published between January 2012 and December 2024. Studies were considered if they included physical rehabilitation strategies as part of a community-based rehabilitation program for individuals with stroke aged ⩾18 years in low-resource settings. Titles, abstracts, and full texts were screened by multiple authors for inclusion. A predefined template that covered physical rehabilitation strategies, setting, providers, frequency, session duration, and program duration was used for data extraction. Results were synthesized narratively. After screening 2892 abstracts, 25 studies were included from 11 countries throughout Asia, Africa, and South America. Most studies were carried out in middle-income countries, with only one study taking place in a low-income country (Uganda). Over half of the studies (n = 16) were randomized controlled trials (RCTs). The physical rehabilitation programs were primarily delivered at home, in person, by a single healthcare professional, typically a physiotherapist or nurse. Session duration was not specified for more than half of the studies. Where reported, sessions were 1 h or less, usually occurring at least once weekly over a 2-to-3-month period. Over 36 different outcome measures were identified, with the Barthel Index being the most common (48%). Overall, 10 RCTs showed a statistically significant difference between intervention and control groups, while five RCTs had no significant difference at the post-intervention outcome evaluation. None of the included publications reported costs or cost-effectiveness data.Conclusion:Community-based rehabilitation programs in low-resource settings differ in their physical rehabilitation strategies and characteristics. While the evidence base in this field is growing, the lack of cost-effectiveness evaluations means there is limited guidance to inform investment in, or optimization of, these multi-component, community-based programs.

This article explores some of the implications of a non-governmental organisation (NGO) initiated community-based rehabilitation (CBR) programme, for HIV-related task-shifting programmes which have been recommended by the World Health Organisation (WHO) as an important aspect of HIV prevention, treatment and care programmes. The CBR programme is run by multi-skilled community rehabilitation facilitators (CRFs) in a low income, rural context in KwaZulu-Natal, South Africa, and explicitly recognises the multiple facets of disability. As such, the programme focuses on both the physical and social aspects of living with disabilities. A qualitative approach was used to conduct this study, and semi-structured interviews were conducted with beneficiaries of the programme (n == 35), home and community-based care givers (HCBCs) (n == 13), and managers (n == 2). A focus group discussion was conducted with CRFs (n == 5). We found that the CBR programme successfully delivered rehabilitation services at a community level and that multi-skilled CRFs are an effective means of implementing CBR programmes in low-income rural areas. The developmental focus of the programme created a range of benefits for people with disabilities, including: physical rehabilitation, emotional support and counselling, access to grants, social inclusion and accessing assistive devices. Central to the programme's success was the maintenance of relationships and partnerships at different levels in the community, these included relationships between HCBCs and CRFs, between CRFs and therapists, and between the NGO and the various participants in the programme. However, the NGO struggled to maintain a partnership with the relevant government departments and this had important implications for the programmes sustainability. In conclusion, we argue that this programme's use of multi-skilled mid-level workers who have undergone effective training programmes in CBR demonstrates that a wide range of rehabilitation activities can be effectively undertaken at a community level, and that this programme provides an important example of how the WHO's task-shifting guidelines for HIV treatment, care and prevention can be implemented.

Community-based drug rehabilitation programs expose clients to everyday social realities, including stigma, peer pressure, and family dynamics, which may shape how self-esteem is rebuilt during recovery. Yet, research on self-esteem in community-based intervention contexts remains limited compared with studies in formal rehabilitation institutions. This study aimed to explore the meaning of self-esteem among clients undergoing rehabilitation in a Community-Based Intervention (IBM) program in an Indonesian village, using Coopersmith’s framework (power, virtue, competence, and significance). A qualitative phenomenological design was employed. Two IBM clients who had participated in rehabilitation for more than three months were selected, and data were collected through in-depth interviews, supplemented by triangulation with family members and recovery agents. Data were analyzed using Miles and Huberman’s procedures (data reduction, display, and conclusion drawing). The findings revealed four interrelated themes: power (variations in self-control and relapse-prevention strategies), virtue (uneven moral–religious change facilitated by mentoring), competence (growth in technical and/or social skills linked to confidence and reintegration), and significance (self-worth shaped by family support, community acceptance, and shifts in stigma). The study concludes that self-esteem in IBM clients is not merely an internal trait but is co-constructed through psychological regulation, skill development, and social recognition within the community ecology. Practically, IBM services should integrate structured self-esteem strengthening through relapse-management coaching, competency training, and stigma-reduction initiatives involving families and local communities. Future research should involve larger samples, longitudinal designs, and comparative analyses across community versus institutional rehabilitation settings.

BackgroundThe 2006 United Nations Convention on the Rights of Persons with Disabilities states that the achievement of equal rights, empowerment and social inclusion of people with disabilities requires comprehensive rehabilitation services encompassing all components of the World Health Organization Community based rehabilitation (CBR) matrix: health, education, livelihood, social and empowerment. CBR programs specifically aim to deliver such comprehensive interventions. In the present study, we investigate the impact of a CBR program in Afghanistan on all these components.MethodsWe enrolled 1861 newly recruited CBR participants with disabilities in the study, from 169 villages between July 2012 and December 2013 as well as 1132 controls with disabilities randomly selected through a two-stage process within 6000 households from 100 villages in the same provinces but outside the catchment area of the CBR program. We interviewed them again after one (midline) and two (end-line) years in the study. Using propensity score matching and difference in difference analysis, we estimated the impact of the CBR on outcomes of interest, namely mobility, activities of daily living, communication, participation in social and community life, emotional well-being and employment.ResultsThree years on average into the CBR program, participants showed a significant and close to medium effect size reduction in emotional (Cohen’s d = − 0.48, 95%CI[− 0.58--0.38]), and social participation challenges (Cohen’s d = − 0.45, 95%CI[− 0.53−− 0.36]); small to medium effect size reduction in unemployment (Cohen’s d = − 0.21, 95%CI[− 0.33--0.10]), activities of daily living (Cohen’s d = − 0.26, 95%CI[− 0.35--0.18]), mobility (Cohen’s d = − 0.36, 95%CI[− 0.44--.29]) and communication challenges (Cohen’s d = − 0.38, 95%CI[− 0.46--0.3]).ConclusionsOur study indicates that a CBR program may provide positive rehabilitation outcomes for persons with disabilities even in a conflict context, and improve overall well-being of all participants with disabilities, whatever their impairment, individual characteristics and the CBR matrix components considered.Trial registrationISRCTN, ISRCTN50214054. Registered August 5th 2020 - retrospectively registered

Cancer survival is often accompanied by late effects that can be mitigated by tailored rehabilitation. In Norway, this has traditionally been offered as residential programs, whereas community-based cancer rehabilitation programs are lacking. This study aimed to assess the feasibility and acceptability of a newly developed community-based multidimensional cancer rehabilitation program in Norway. A feasibility study with a mixed methods explanatory sequential design was implemented. The intervention was a 12-week group-based rehabilitation program comprising 5 components: goal setting, physical exercise, psychoeducation, individual follow-up consultations, and peer support. Feasibility was assessed through recruitment, retention, and intervention delivery. Acceptability was assessed through intervention adherence and participant evaluation. Qualitative data were generated from focus group interviews. Statistical analyses were descriptive, and qualitative data were transcribed and analyzed using framework analyses. Sixty participants started, and 55 completed the 12-week rehabilitation program. The majority were female (80%), and the mean age was 56 years. The largest diagnostic group was breast cancer (42%). Retention was high (92%), as were adherence rates for all intervention components. The exercise component was rated the most beneficial, followed by individual consultations and peer support. Qualitative findings contributed to explaining the high adherence and positive evaluation. High retention, strong adherence, and positive evaluation imply that the community-based program was feasible and acceptable to cancer survivors. The results will aid intervention refinement and contribute to a future randomized controlled trial to examine its effectiveness. If successful, the rehabilitation program could be implemented in the Norwegian Cancer Pathway "Home."

Purpose: In this paper, we measure the effectiveness of Community-Based Rehabilitation (CBR) programmes in promoting the well-being of people with disabilities and removing the barriers to their participation in family and community decision-making processes. Method: To evaluate the impact of the CBR programme, we use data from a large-scale control study in Karnataka, India. Propensity score matching is used to evaluate the impacts on disabled persons after 2, 4 and 7 years of entering the CBR. The theoretical framework for the analysis is based on the CBR guidelines, which are combined with the International Classification of Functionings (ICF), the United Nations Convention on the Rights of People with Disabilities (UN CRPD) and Amartya Sen’s capability approach. Results: CBR has a positive impact on the well-being of persons with disabilities participating in the programme and particularly on their participation within the family and the society at large. Conclusions: CBR programmes have a multidimensional and positive impact on individual and collective capabilities; on individual, agency and social empowerment.Implications for RehabilitationCommunity-Based Rehabilitation (CBR) can make a lasting difference in the life of persons with disabilities.CBR improves participation and inclusion of persons with disabilities in the family and in the community.

This study examines the biopsychosocial predictors of drug use and dependence among Filipino drug users enrolled in community-based drug rehabilitation. Data from 925 clients revealed that the severity of drug use, cigarette and alcohol use, recovery skills, and mental health problems predict drug dependence. Family support, life skills, and psychological well-being are indirect predictors of severity of use. Results also revealed differences in predictors by sex, level of use, and type of clients. These findings highlight the importance of a client-centered approach to treatment and suggest what might be critical elements in a community-based drug rehabilitation program in the Philippines.