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From policy intent to equitable reach: a qualitative study of the hybrid community-based rehabilitation service in China
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DOI：10.1186/s12939-026-02985-x.png)
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Abstract
En 中文
Community-based rehabilitation (CBR) is promoted to improve rehabilitation access and social participation for persons with disabilities. In China, Self-Help and Peer Support for Persons with Disabilities (SHPSPD) service is the hybrid CBR service intended to complement clinical rehabilitation by extending self-help and peer-enabled support into community settings. Its early implementation raises an equity-relevant implementation question: whether the service can reach regions and participant groups with sufficient continuity and fit. We conducted a multisite qualitative study of SHPSPD implementation across five regions in a representative eastern Chinese province. Semi-structured interviews and focus groups were conducted with 43 stakeholders. Data were analyzed using deductive-inductive thematic analysis informed by the Consolidated Framework for Implementation Research (CFIR). CFIR construct ratings were assigned by region, and Expert Recommendations for Implementing Change (ERIC) matching was used to identify candidate implementation strategies. Stakeholders valued SHPSPD as a promising hybrid CBR service that could support psychosocial recovery, self-efficacy, family–peer co-participation, and community reintegration. Innovation characteristics and individual agency generally facilitated implementation. Barriers clustered in the outer setting, inner setting, and implementation process, including short-cycle project-based financing, weak medical–social referral pathways, uneven organizational resources, limited needs assessment, weak feedback mechanisms, and activity-count-oriented monitoring. These conditions risked selective reach and uneven continuity, particularly for participants and regions less connected to rehabilitation and disability administration networks. Regional CFIR construct ratings showed an implementation gradient, with higher-performing sites benefiting from stronger leadership, resources, cross-sector collaboration, and learning routines. SHPSPD has potential to extend rehabilitation beyond clinical settings through self-help, peer support, family-peer co-participation, and community reintegration. However, equitable scale-up will require implementation systems that protect its relational peer-support functions while strengthening referral pathways, needs assessment, stable workforce support, and equity-sensitive monitoring. CFIR construct ratings and CFIR-ERIC matching provided a practical route from determinant diagnosis to strategy generation for community-based disability services.
Keywords:
Community-based rehabilitation
Persons with disabilities
Implementation science
Peer support
Self-help
Health equity
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