Background

Acquired brain injury (ABI) is a major cause of disability worldwide, affecting approximately one in every 500 people. Access to a range of rehabilitation and healthcare services is crucial for individuals with ABI to achieve long-term recovery, as these services can address cognitive, functional, social, and behavioural needs. Unfortunately, many people with ABI do not receive the necessary post-acute rehabilitation and healthcare services or are unable to access specialised follow-up care. This can result in unmet needs and poor outcomes. Access to these services can be influenced by factors beyond an individual's needs, such as service availability and funding, leading to disparities in the type and intensity of services received. In the current climate of emphasising individualised and empowered service users, it is essential to understand the personal experience of accessing these services and what constitutes appropriate care. Previous research on access to post-acute rehabilitation and healthcare services has focused mainly on broad domains of unmet need, satisfaction with services, and barriers to healthcare. As a result, this research does not sufficiently address the complex and often hidden characteristics of access, such as whether the care received is appropriate for the individual's needs. Therefore, it is unclear to what extent post-acute rehabilitation and healthcare services are meeting the needs of individuals with ABI.

Aim

The overall aim of this thesis was to explore the personal perspective of people with ABI on access to post-acute rehabilitation and healthcare services with a focus on the concept of adequacy and appropriateness of access. The specific research questions developed were: (1) Drawing on the literature, what are the key characteristics of appropriate access, as defined by the personal experiences of people with ABI, and what are the knowledge gaps in this literature?; (2) How do people with ABI perceive their needs and the adequacy of their realised access to post-acute services after discharge from inpatient rehabilitation and how is this influenced by access to funding and specialist transitional rehabilitation?; (3) What is the influence of perceived rehabilitation adequacy and unmet rehabilitation needs after discharge from inpatient brain injury rehabilitation on outcomes such as health-related QoL, psychological wellbeing, global functioning and community integration and return to work; (4) What services are included in the post-acute rehabilitation and healthcare network of individuals with ABI during the first six months after their discharge from inpatient rehabilitation, how is this network structured and how do these relate to access to funding and specialist transitional rehabilitation and concepts of appropriateness? [...]