A qualitative synthesis to explore clinician and user experiences of accessing prosthetic and orthotic services in low- and middle-income countries using the three-delays model as a framework

Kombe, Eunice; Prior, Yeliz; Ackers, Helen Louise; Day, Sarah; Donovan-Hall, Maggie

Abstract

Purpose
To use the “three delays model” as a framework to identify and synthesise qualitative literature that identifies barriers to accessing and utilising P&O services in low-middle-income countries from the perspective of individuals with disabilities and clinicians.

Methods
A systematic search of four databases was used to identify research exploring user and clinician experiences in accessing P&O services in LMICs. Selected search terms and combinations identified through an adapted version of the SPIDER tool were used to identify studies. All retrieved articles were critically appraised using the CASP tool. Data were extracted, and themes were synthesised using a deductive thematic approach guided by the three-delays model.

Results
Ten key themes were generated and linked to the three-delays model. Fear of perceived financial implications, transportation, and respectful care were some of the themes affecting accessibility in the first, second, and third delays, respectively. The findings suggest that the delays are interconnected components that might have a cascading effect on access to P&O services as a whole. Minimising delays can improve the accessibility of P&O services in low-middle-income countries.

IMPLICATIONS FOR REHABILITATION
Prosthetic and orthotic services in low- and middle-income countries present with perceived high costs, transportation, limited resources, and sex-related challenges, limiting access to care.

The findings of this synthesis suggest that the three-delays model has practical implications for improving rehabilitation services and overcoming barriers to accessing and utilising prosthetic and orthotic services in low- and middle-income countries.

The highlighted barriers are categorised into delays and form interlinked components that can impact overall access to prosthetic and orthotic services.

Implementing strategic measures to address the underlying causes of delays can improve the accessibility to prosthetic and orthotic services in low- and middle-income countries.

• Journal Article Type: Review
• Acceptance Date: Jun 2, 2025
• Online Publication Date: Jun 9, 2025
• Deposit Date: Jun 20, 2025
• Publicly Available Date: Jun 20, 2025
• Journal: Disability and Rehabilitation
• Print ISSN: 0963-8288
• Electronic ISSN: 1464-5165
• Publisher: Taylor and Francis
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1080/09638288.2025.2516170