Treatment Access Barriers

When taxis were provided, participants described them as enabling attendance that would otherwise have been impossible. Advance information about location, transport options, toilet facilities, and accessibility made attendance more possible, and participants valued receiving it early enough to prepare. Public transport was frequently avoided because walking distances, standing, disorientation, dizziness, confusion, and lack of reliable seating could make journeys physically and mentally difficult. Long journeys caused fatigue before therapy began and left participants worried about having enough energy for the return trip. Travel was one of the most prominent burdens, with participants often dreading journeys due to uncontrollable factors such as transport strikes, train delays, inaccessible routes, and walking distances. Morning sessions were especially difficult for participants with MLTCs because pain was often worse on waking, and time was needed for medication, personal care, and for symptoms to settle; afternoon sessions were preferred. Travel problems affected therapy quality by requiring recovery time after arrival and reducing the available therapy time for late arrivals.