“I will die before God wants me to.” Factors that affect older adults’ attendance, of public healthcare rehabilitation services in Gauteng, South Africa

Aim: Healthcare facilities are valued out-of-home places older adults’ visit and a key constituent of Healthy Ageing. The study explored factors that affected older adults’ rehabilitation attendance in Gauteng’s public healthcare services, strategies to mitigate the barriers they confronted, and suggestions for improving their experiences.

Methods: An exploratory concurrent mixed methods design saw 84 multi-professional rehabilitation clinicians, working in public healthcare facilities, and interview with 393 community dwelling older adults in their rehabilitation practices. A semi-structured interview guide was used. Clinicians kept field notes and participated in discussion groups. Qualitative data were predominant and analysed through inductive content analysis. Quantitative data ware analysed using descriptive statistics. 

Results: Transport and fiscal poverty were predominant factors affecting older adult attendance of rehabilitation services in urban low-income communities. These affected compliance with attendance and effort exertion during rehabilitation. The perceptions and personal experiences of older adults when attending rehabilitation, along with their preference to attend out-of-home places that have multiple purposes and where they can be of use to their communities, were also factors that should be taken into consideration.

Conclusion: Older adults’ living in South African urban areas, access to public healthcare is intrinsically tied to the communities that they live in. Factors outside of and inside healthcare affected their rehabilitation attendance. Cognisance of and insight into the complex and multifactorial nature of these factors is necessary for rehabilitation service providers to become part of strategies that address older adults’ access to public healthcare rehabilitation. Actuating and strengthening resources within families and communities, fortifying the dignity of older service users, and incorporating the principles of community-oriented rehabilitation services are suggested as starting points.

Implications for rehabilitation: This article provides evidence towards understanding, insight, and knowledge of the realities that South African urban older adults, from low-resourced communities, face to get to rehabilitation. Attending rehabilitation appointments is affected by multiple factors such as transport poverty, limited funds, crime, public humiliation, personal health, and experiences at medical facilities. These findings contribute to the WHO’s Decade of Healthy Ageing agenda and could be taken into consideration by national and local rehabilitation service providers and related stakeholders.

Limitations: Due to the uniqueness of South African settings and the use of a convenience sample, external validity is limited. The authors suggest that the results be seen as transferable only to other urbanised areas within South Africa. Interviews were held with older adults who arrived at healthcare facilities. The views and realities of those that cannot make it to healthcare facilities might add additional evidence to the problem investigated. Within South Africa (Ramafikeng & Marshall, 2023), and in other African countries (Kori-Siakpere et al., 2024), differences in age, language, education, and ethnicity affect communication and interaction. In this study, there were differences in age, language, education, and ethnicity between clinicians and the older adults they were interviewing. During discussion groups after the interviews, clinicians reported experiencing these differences as a barrier when conducting the interviews. This could have affected the quality and content of the interviews.