Project – Community-Based Rehabilitation and Social Participation of Persons with Physical Disabilities: A Study of Selected Communities in Enugu State

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Disability is an important public health, social development and human-rights concern because its effects extend beyond an individual’s physical functioning to participation in family, community, educational, economic and social activities. Persons with physical disabilities may experience difficulties in mobility, self-care, communication, employment and participation in community life, particularly where environmental and attitudinal barriers are present. The World Health Organization (WHO) and World Bank have emphasized that disability is shaped not only by an individual’s health condition but also by interactions with environmental and social barriers. Consequently, rehabilitation has increasingly moved beyond institutional and hospital-based approaches towards models that promote independence, empowerment and inclusion within the community. Community-Based Rehabilitation (CBR) emerged as an important strategy for addressing these needs by bringing rehabilitation closer to the places where people live and by involving persons with disabilities, their families and communities in the rehabilitation process (World Health Organization [WHO], 2010).

Community-Based Rehabilitation is a multisectoral strategy designed to improve the quality of life of persons with disabilities through community development, rehabilitation, equalization of opportunities and social inclusion. The WHO CBR Guidelines explain that CBR is not restricted to medical treatment but encompasses health, education, livelihood, social participation and empowerment. The approach seeks to strengthen the capacity of persons with disabilities and their families while mobilizing community resources and mainstream services to remove barriers to participation. The social component of CBR is particularly important because it emphasizes relationships, family life, community activities, recreation, culture, religion and participation in social organizations. In this sense, rehabilitation is considered successful not merely when an individual gains improved physical functioning, but when the individual is also able to participate meaningfully in everyday community life (WHO, UNESCO, ILO, & IDDC, 2010).

Social participation refers to an individual’s involvement in activities and roles that are meaningful within family and community life. For persons with physical disabilities, social participation may include attending religious activities, visiting friends and relatives, participating in community meetings, engaging in recreational activities, pursuing education or employment, contributing to household decisions and taking part in community development. However, physical limitations can interact with inaccessible buildings, transportation difficulties, inadequate assistive devices, poverty, discrimination and negative social attitudes to restrict participation. A study by Umunnah et al. (2023) involving persons with mobility-related disabilities in selected communities of Enugu State examined the relationship among quality of life, self-esteem, self-efficacy and social participation. The study involved 200 participants from four communities with CBR services and demonstrated the relevance of social participation as an important dimension of the wellbeing of persons living with mobility-related disabilities (Umunnah et al., 2023).

The relevance of CBR becomes clearer in settings where conventional rehabilitation services are concentrated in hospitals or urban centres and are therefore difficult for many people in rural and underserved communities to access. Community-based approaches can reduce geographical and financial barriers by connecting rehabilitation services with families, local organizations, community leaders and existing health and social systems. In Nigeria, Bashir, Hassan, and Ibrahim (2020), in a scoping study of CBR literature, reviewed studies published between 1990 and 2018 and found that only 14 studies met their inclusion criteria. Although the review identified increasing interest in CBR in Nigeria, the authors concluded that more well-designed studies were required to provide stronger evidence for CBR practice, management and policy. This finding is important because the effectiveness of rehabilitation cannot be assumed to be uniform across communities; local social, economic, cultural and environmental conditions may influence whether rehabilitation services actually improve the participation of persons with disabilities (Bashir et al., 2020).

The Nigerian context presents several challenges that may limit the social participation of persons with physical disabilities. These challenges may include inaccessible public buildings, inadequate transportation, limited access to assistive devices, unemployment, poverty, social stigma and inadequate rehabilitation services. Nigeria’s National Development Plan 2021–2025 recognizes the considerable barriers faced by persons with disabilities and identifies rehabilitation, assistive devices, accessible infrastructure and social and economic inclusion as important areas requiring government attention. The Plan also emphasizes that persons with disabilities may encounter cultural stigma and exclusion from social, economic and political opportunities. Such barriers are important because a person may receive physical rehabilitation but still remain socially excluded if the surrounding environment is inaccessible or if negative community attitudes prevent meaningful participation (Federal Republic of Nigeria, 2021).

Evidence from Enugu State further illustrates the importance of strengthening community-based rehabilitation. Igwesi-Chidobe and Okafor (2013) reported that Enugu State had limited development of well-defined community physiotherapy and CBR services and noted the need for greater involvement of rehabilitation professionals in community settings. More recently, Aroh et al. (2020), in a study of 53 physiotherapists in Enugu Metropolis, found strong support for increasing the accessibility, affordability and awareness of physiotherapy and rehabilitation services, particularly for people living in rural areas. However, the study also identified barriers including poor accessibility to rural communities, inadequate infrastructure and inadequate incentives for rural-based therapists. These findings suggest that the availability of rehabilitation professionals and services is only one part of the challenge; the organization, accessibility and community orientation of rehabilitation services are equally important in determining whether persons with disabilities can benefit from rehabilitation and participate actively in community life (Igwesi-Chidobe & Okafor, 2013; Aroh et al., 2020).

Empirical evidence also indicates that CBR can produce outcomes that extend beyond physical rehabilitation to broader wellbeing and social functioning. Umunnah et al. (2023) found that Nigerian persons with physical disabilities living in communities with CBR programmes had better quality-of-life and self-esteem outcomes than comparable persons in non-CBR communities. Similarly, a recent systematic review found that participation in CBR and empowerment-oriented programmes was consistently associated with improvements in social inclusion, empowerment, participation and access to services, although the review also noted the need for stronger evaluation designs (Umunnah et al., 2023; Frontiers in Rehabilitation Sciences, 2026). Against this background, there is a strong justification for examining the relationship between community-based rehabilitation and social participation among persons with physical disabilities in selected communities in Enugu State. Such a study can provide community-level evidence on whether rehabilitation services are contributing to meaningful participation and inclusion, identify factors that may limit participation, and provide information useful for strengthening disability-inclusive rehabilitation programmes in the state.

1.2 Statement of the Problem

Persons with physical disabilities require more than clinical treatment to live independently and participate fully in society. They may require assistive devices, environmental modifications, family support, vocational opportunities, social support and accessible community services. Despite the development of disability and rehabilitation policies, many persons with disabilities in Nigeria continue to encounter barriers that restrict their participation in social and economic activities. The National Development Plan 2021–2025 identifies limited access to rehabilitation services and assistive devices, inaccessible infrastructure and social stigma among the major challenges affecting persons with disabilities in Nigeria. These barriers may result in isolation and reduced opportunities to participate in family, community, educational, religious and economic activities (Federal Republic of Nigeria, 2021).

A major concern is that conventional rehabilitation services may focus primarily on improving physical functioning without sufficiently addressing the environmental and social barriers that determine whether an individual can participate in community life. WHO, UNESCO, ILO, and IDDC (2010) emphasized that CBR is intended to promote inclusion, empowerment and participation alongside rehabilitation and access to health services. However, evidence from Nigeria suggests that CBR remains insufficiently developed in many settings. Bashir et al. (2020) found limited empirical literature on CBR in Nigeria and concluded that additional well-designed studies were needed to strengthen the evidence base. In Enugu specifically, Igwesi-Chidobe and Okafor (2013) reported limitations in the development of community physiotherapy and CBR services, while Aroh et al. (2020) identified accessibility, infrastructure and other barriers to the effective development of CBR in Enugu Metropolis.

Another problem concerns the actual level of social participation among persons with physical disabilities who live in communities where CBR services are available. The existence of a CBR programme does not automatically guarantee that persons with disabilities will be socially included. Factors such as severity of physical limitation, availability and use of mobility aids, self-esteem, self-efficacy, family support, community attitudes, accessibility of public spaces and economic circumstances may influence participation. Umunnah et al. (2023) specifically examined persons with mobility-related disabilities in four Enugu State communities with CBR services, demonstrating that social participation is a relevant outcome within the local disability and rehabilitation context. However, there remains a need for further community-level investigation into how CBR relates specifically to the social participation of persons with physical disabilities across selected communities.

The central problem, therefore, is the limited empirical evidence on the extent to which community-based rehabilitation contributes to the social participation of persons with physical disabilities in selected communities in Enugu State. While existing studies have examined CBR availability, professional attitudes, quality of life and related outcomes, there is still a need to establish whether the rehabilitation services available at community level are associated with meaningful participation in social and community activities. Understanding this relationship is important for rehabilitation professionals, community leaders, government agencies, disability organizations and families because effective rehabilitation should ultimately contribute to the ability of persons with disabilities to live with dignity, exercise choice and participate in society. The present study therefore seeks to examine community-based rehabilitation and social participation of persons with physical disabilities in selected communities in Enugu State, with the aim of generating evidence that can support more inclusive and participation-oriented rehabilitation practices.

1.3 Purpose of the Study

The main purpose of this study is to examine community-based rehabilitation and social participation of persons with physical disabilities in selected communities in Enugu State.

Specifically, the study seeks to:

1. examine the availability and accessibility of community-based rehabilitation services for persons with physical disabilities in selected communities in Enugu State;
2. determine the level of social participation among persons with physical disabilities in the selected communities;
3. identify the major factors that influence social participation among persons with physical disabilities in the selected communities; and
4. determine the relationship between community-based rehabilitation and social participation of persons with physical disabilities in the selected communities.

1.4 Research Questions

The following research questions will guide the study:

1. What community-based rehabilitation services are available and accessible to persons with physical disabilities in selected communities in Enugu State?
2. What is the level of social participation among persons with physical disabilities in the selected communities?
3. What factors influence the social participation of persons with physical disabilities in the selected communities?
4. What relationship exists between community-based rehabilitation and social participation of persons with physical disabilities in the selected communities?

1.5 Research Hypothesis

The following null hypothesis will be tested at the 0.05 level of significance:

H₀: There is no significant relationship between community-based rehabilitation and social participation among persons with physical disabilities in selected communities in Enugu State.

1.6 Significance of the Study

The study will be significant to persons with physical disabilities because it will draw attention to the importance of rehabilitation services that extend beyond physical functioning to social inclusion and meaningful participation. The findings may help identify barriers that prevent persons with physical disabilities from taking part in community activities and may provide evidence for improving rehabilitation services.

The study will also be useful to rehabilitation professionals, including physiotherapists, occupational therapists, medical rehabilitation specialists, social workers and other community-based rehabilitation practitioners. The findings may help professionals understand the social outcomes associated with rehabilitation and encourage the development of interventions that address physical, environmental, psychological and social needs simultaneously.

The study will be beneficial to government agencies and policymakers responsible for disability affairs, health, social development and community development. The findings may provide evidence for strengthening community-based rehabilitation programmes, improving access to assistive devices, developing accessible infrastructure and promoting disability-inclusive community policies.

Community leaders, traditional institutions, religious organizations and non-governmental organizations may also benefit from the study. The findings may increase awareness of the barriers experienced by persons with physical disabilities and encourage communities to develop more inclusive social structures and activities.

The study will further be useful to families and caregivers of persons with physical disabilities. By identifying factors that promote or restrict social participation, the study may encourage families to provide appropriate social support and facilitate the involvement of persons with disabilities in community activities and decision-making.

Finally, the study will serve as a useful reference for researchers and students interested in disability studies, rehabilitation, social work, public health, physiotherapy, community development and inclusive development. It may provide a basis for further studies on CBR and social participation in other communities and regions of Nigeria.

1.7 Scope of the Study

The study will focus on Community-Based Rehabilitation and Social Participation of Persons with Physical Disabilities in Selected Communities in Enugu State.

The geographical scope will cover selected communities in Enugu State, South-East Nigeria, where persons with physical disabilities reside and where community-based rehabilitation services or related rehabilitation support can be identified.

The content scope will focus on the availability, accessibility and utilization of community-based rehabilitation services and their relationship with social participation. Particular attention will be given to rehabilitation support, assistive devices, health and rehabilitation services, family and community support, accessibility, empowerment and participation in family, religious, recreational, economic and community activities.

The population of the study will consist of adult persons with physical disabilities residing in the selected communities. Persons whose primary disability is exclusively sensory, intellectual or psychosocial will fall outside the principal population unless they also have a physical disability relevant to the study.

1.8 Operational Definition of Terms

Community: A geographically identifiable area in which people live, interact and share social, cultural, economic or institutional resources.

Community-Based Rehabilitation (CBR): A community-oriented strategy for improving the quality of life and inclusion of persons with disabilities through rehabilitation, health, education, livelihood, social participation and empowerment.

Disability: A condition involving an impairment that, in interaction with environmental or attitudinal barriers, may restrict an individual’s ability to perform activities or participate fully in society.

Physical Disability: A physical impairment affecting movement, mobility, coordination or physical functioning and which may restrict an individual’s ability to perform activities or participate in community life.

Rehabilitation: A set of interventions intended to optimize functioning and reduce disability in individuals experiencing health conditions or impairments.

Social Participation: The extent to which a person with a disability takes part in meaningful activities, relationships, roles and interactions within family and community life.

Social Inclusion: The process through which persons with disabilities are accepted, supported and enabled to participate equally in social, economic, cultural and community activities.

Assistive Devices: Products, equipment or technologies used to maintain or improve the functioning and independence of persons with disabilities, such as wheelchairs, walking aids, prostheses and other mobility-support devices.

Community-Based Rehabilitation Services: Rehabilitation-related health, social, educational, livelihood, empowerment or support services delivered or facilitated within the community or designed to connect persons with disabilities with community and mainstream services.

Persons with Physical Disabilities: Individuals with physical impairments affecting movement or physical functioning who reside in the selected communities covered by this study.

Project – Community-Based Rehabilitation and Social Participation of Persons with Physical Disabilities: A Study of Selected Communities in Enugu State