Evaluation of rehabilitation services in low resourced settings: a qualitative geographic information systems approach - NU/LSHTM project

Title of PhD project / theme

Evaluation of rehabilitation services in low resourced settings: a qualitative geographic information systems approach.

Supervisory team

Lead: Tracey Smythe (
Jayne Webster 

Nagasaki University 
Miho Sato (


Brief description of project / theme

There are approximately one billion people with disabilities worldwide, more than 80% of whom live in Low and Middle-Income Countries (LMIC). On average, people with disabilities have greater healthcare needs, yet they face a range of barriers in accessing health and rehabilitation services. Consequently, people with disabilities experience worse health than others in the population. Research on access to health services in LMIC has largely relied on self-reported survey data. Innovative methods to identify barriers to healthcare facing people with disabilities, and opportunities for inclusion, are urgently needed.  

The successful candidate will use a qualitative geographical information systems approach to identify how people with disabilities interact with and use their local health services. The objective of this project is to develop and test a model of access to healthcare services for people with disabilities in resource limited settings. The model will combine physical distance and accessibility data from geographical information systems (GIS) with qualitative data that includes perceptions and experiences of access of people with disabilities. The visual data identified by the GIS will be complemented by the narratives of people with disabilities to gain an understanding of the interactions between people and the health system. The candidate is invited to identify a suitable study population within a LMIC in Asia.

To investigate geographic accessibility and spatial coverage, two accessibility models will used (1) distance to the nearest rehabilitation service provider and (2) population ratio of rehabilitation facilities. The digital elevation model (EDM) obtained from Aster GEDM, and AccessMod5 will be used for analysis. Qualitative methodologies may include photovoice, observations, participant diaries and interviews.  

The role of LSHTM and NU in this collaborative project

The questions that have been developed for this proposed project are aimed to specifically address LSHTM’s and NU’s strategic priority of effective translation of research knowledge into policy and practice. This research is highly relevant to improved delivery of clinical and rehabilitation services and health system strengthening. 

The study will advance novel methodologies, triangulating GIS and qualitative data, to generate a model on access to health services in low resourced contexts that will support efforts to improve access for marginalised people in underserved areas. 

LSHTM will provide rehabilitation, quantitative and GIS expertise through the expertise of the primary supervisor (Smythe) and the advisory committee. NU will provide expertise in qualitative research and health seeking behaviour (Sato) to strengthen research in methodology and knowledge translation in both institutions.

Particular prior educational requirements for a student undertaking this project

Expertise in rehabilitation, epidemiology or geographic information systems; training in qualitative data collection and analysis; familiarity in culture and customs in Asia (or of a particular country to be proposed).

Skills we expect a student to develop/acquire whilst pursuing this project

The successful candidate will develop: 

  • Experience conducting systematic reviews of the literature 
  • Expertise in advanced use of stata, evaluation techniques, advanced statistics and epidemiology 
  • Expertise in qualitative geographical information systems design and analysis 
  • Experience in health system strengthening, and development of recommendations to improve clinical and rehabilitation services