Post community hospital discharge rehabilitation attendance: Self-perceived barriers and participation over time.
BACKGROUND
This study aimed to examine the attendance rates of post-discharge supervised rehabilitation as recommended by the multidisciplinary team at discharge among subacutely disabled adults and the barriers preventing adherence.


METHODS
Patients were from a community hospital, aged 40 years or older. They had been assessed by a multidisciplinary team to benefit from rehabilitation after discharge, were mentally competent and communicative. We used a sequential qualitative-quantitative mixed methods study design. In the initial qualitative phase, we studied the patient-perceived barriers to adherence to rehabilitation using semi-structured interviews. Emerging themes were then analysed and used to develop a questionnaire to measure the extent of these barriers. In the subsequent quantitative phase, the questionnaire was used with telephone follow-up at 3, 6, 9 and 12 months after discharge.


RESULTS
Qualitative phase interviews (n = 41) revealed specific perceived financial, social, physical and health barriers. At the start of the quantitative phase (n = 70), 87.1% of the patients viewed rehabilitation as beneficial, but overall longitudinal attendance rate fell from 100% as inpatient to 20.3% at 3 months, 9.8% at 6 months, 6.3% at 9 months and 4.3% at 12 months. The prevalence of physical and social barriers were high initially but decreased with time. In contrast, the prevalence of financial and perceptual barriers increased with time.


CONCLUSIONS
Attendance of post-hospitalisation rehabilitation in Singapore is low. Self-perceived barriers to post-discharge rehabilitation attendance were functional, social, financial and perceptual, and their prevalence varied with time.
Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.
Abel W L
AW
Chen
Yan Tong
YT
Koh
Sean W M
SW
Leong
Louisa W Y
LW
Ng
Patricia S Y
PS
Lee
Gerald C H
GC
Koh
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006297:Health Services Accessibility; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010351:Patient Discharge; D036301:Qualitative Research; D012046:Rehabilitation; D012649:Self Concept; D011795:Surveys and Questionnaires; D013997:Time Factors