Bridging healthcare disparities: a systematic review of healthcare access for disabled individuals in rural and urban areas
Amer Mesmar, Godfrey Mbaabu Limungi, Mohammed Elmadani, Klára Simon, Osama Hamad, Lívia Tóth, Éva Horváth, Orsolya Máté
Abstract
Objective: This review will examine existing research to compare the differences in healthcare access for people with disabilities in rural vs. urban areas. The goal is to identify common obstacles and helpful factors that affect their ability to get healthcare, which can inform the creation of specific programs to close these gaps. Methods: This systematic review was pre-registered with PROSPERO (Registration No. CRD42025648258). A comprehensive search was conducted across databases including PubMed, Scopus, Web of Science, and the Cochrane Library, for peer-reviewed articles published between January 1, 2010, and December 31, 2024. Studies were included if they addressed healthcare access for disabled individuals and made comparisons between rural and urban settings. Data extraction was performed using standardized forms, and quality assessment was conducted using the Mixed Methods Appraisal Tool (MMAT). Data synthesis involved a narrative synthesis and thematic analysis to identify key barriers and facilitators to healthcare access in rural and urban areas. The reporting of this review follows the PRISMA guidelines. Results: Eight studies from Peru, China, the United States, Mozambique, and South Africa were included in the final review. A clear distinction emerged between the barriers to healthcare access in rural and urban areas. Rural settings were defined by infrastructure-related challenges, such as transportation difficulties, a lower number of healthcare facilities, and limited provider availability. Meanwhile, urban areas presented different barriers, including overcrowded facilities and extended wait times. Both settings struggled with socioeconomic disparities, but the specific barriers and facilitators varied. In rural areas, telemedicine and mobile clinics were identified as key facilitators, while in urban areas, specialized healthcare services and better public transportation were the most helpful in bridging access gaps. Conclusion: This systematic review confirms that disabled individuals face significant, yet distinct, healthcare access disparities depending on their location. In rural areas, the primary barriers are transportation and a lack of facilities, which necessitates the development of community-specific solutions such as mobile clinics and expanded telemedicine. In urban settings, access is hindered by system overcrowding and socioeconomic divides, calling for interventions that improve public transportation access and address systemic inequalities. Ultimately, addressing these disparities requires a dual approach: empowering rural communities with technological and logistical support while simultaneously optimizing urban healthcare systems to be more accessible and equitable. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025648258, PROSPERO CRD42025648258.