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Purpose: Aboriginal and Torres Strait Islander People with a disability continue to experience barriers to service engagement such as mistrust of government services, lack of culturally appropriate support, marginalisation and disempowerment. This meta-synthesis reviews current literature regarding these experiences to explain why services are underutilised. Methods: The meta-synthesis was conducted using a meta-ethnographic approach to synthesise existing studies into new interpretive knowledge. The approach was supported by a search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Ten original research papers utilising a qualitative methodology were extracted. Synthesis of the articles revealed four concepts that were developed into a conceptual model. These include:1) History Matters; 2) Cultural Understanding of Disability Care; 3) Limitations to Current Service Provision; and 4) Delivery of Effective Services. Conclusions: Disability services do not adequately consider the cultural needs of Aboriginal and Torres Strait Islander People or communicate in a culturally appropriate manner. There are expectations that Aboriginal and Torres Strait Islander People acknowledge their disability in alignment with western definitions of disability in order to access services. More work is needed to align disability services with culturally appropriate support to provide better health outcomes. Aboriginal and Torres Strait Islander people with a disability continue to experience barriers to service engagement which must be addressed. An essential gap that must be filled in providing disability services to Aboriginal and Torres Strait Islander people is the acknowledgment of culture as a resolute influence on all client interactions with providers. A cultural model of disability may better align with the experiences of Aboriginal and Torres Strait Islander people than current medical and social models used in healthcare. Disability services need to align better with culturally appropriate support to provide better health outcomes for Aboriginal and Torres Strait Islander people. [ABSTRACT FROM AUTHOR]

PurposeTo identify access barriers to physical rehabilitation for traffic accident (TA) victims with severe disability and build a theoretical model to provide guidance towards the improvement of these services.MethodsQualitative research carried out in the city of Natal (Northeast Brazil), with semi-structured interviews with 120 subjects (19 key informer health professionals and 101 TA victims) identified in a database made available by the emergency hospital. The interviews were analyzed using Alceste software, version 4.9.ResultsThe main barriers present in the interviews were: (1) related to services: bureaucratic administrative practises, low offer of rehabilitation services, insufficient information on rehabilitation, lack of guidelines that integrate hospital and ambulatory care and (2) related to patients: financial difficulties, functional limitations, geographic distance, little information on health, association with low education levels and disbelief in the system and in rehabilitation.ConclusionThe numerous access barriers were presented in a theoretical model with causes related to organizational structure, processes of care, professionals and patients. This model must be tested by health policy-makers and managers to improve the quality of physical rehabilitation and avoid unnecessary prolongation of the suffering and disability experienced by TA survivors.Implications for rehabilitationTraffic accidents (TAs) are a global health dilemma that demands integrality of preventive actions, pre-hospital and hospital care and physical rehabilitation (PR). This study lays the foundation for improving access to PR for TA survivors, an issue of quality of care that results in preventable disabilities.The words of the patients interviewed reveal the suffering of victims, which is often invisible to society and given low priority by health policies that relegate PR to a second plan ahead of prevention and urgent care.A theoretical model of the causes of the problem of access to PR was built. The identified barriers are potentially preventable through the intervention of health policy-makers, managers, regulators and rehabilitation professionals, and by encouraging the participation of patients.Addressing timely access barriers involves the expansion of the supply of services and rehabilitation professionals, regulation and standardization of referencing practises and encouraging the provision of information to patients about continuity of care and their health needs. [ABSTRACT FROM PUBLISHER]