Understanding Barriers and Facilitators to Disability and Rehabilitation Policy Implementation in Gauteng, South Africa: A Qualitative CFIR-Informed Study.

Background: The effective implementation of disability and rehabilitation frameworks is essential for the full participation and social integration of individuals with disabilities. In Gauteng, South Africa, significant challenges persist in the execution of the Framework and Strategy for Disability and Rehabilitation (FSDR). This study aimed to explore the barriers and facilitators to the implementation of the FSDR in Gauteng. Methods: We employed qualitative research methods, including semi-structured interviews and focus group discussions with stakeholders involved in the implementation process, from management to end users. Data were triangulated with a review of paper-based implementation reports from rehabilitation managers. The interview, focus group, and document review data were analyzed using inductive thematic analysis with MAXQDA qualitative data analysis software. Results: Barriers to implementation included resource constraints, organizational inefficiencies, and socio-cultural attitudes toward disability. Facilitators identified included inter-sectoral collaboration, community engagement, and alignment of policies with international guidelines. Using the Consolidated Framework for Implementation Research (CFIR), barriers and facilitators were mapped to domains such as intervention characteristics, outer and inner setting factors, characteristics of individuals, and the implementation process. Key challenges included insufficient awareness and training among healthcare professionals, limited resources, safety concerns, and inconsistent policy implementation. Facilitators such as inter-sectoral collaboration, policy development, provincial training, and advocacy by persons with disabilities were crucial for overcoming these challenges. Conclusion: This study provides valuable insights into the contextual factors influencing disability and rehabilitation policy implementation in Gauteng. By addressing identified barriers and leveraging facilitators, evidence-based strategies can strengthen rehabilitation services, promote social inclusion, and enhance the rights of individuals with disabilities in South Africa and globally.