Fragmented prevention in rural South Africa: a qualitative study of Biokineticists’ perspectives on health system barriers to early detection of non-communicable diseases

Abstract

BACKGROUND: Non-communicable diseases (NCDs) disproportionately affect rural South Africans due to limited healthcare access and delayed diagnoses. Biokineticists, experts in clinical exercise therapy, can aid in the early detection and prevention of NCDs, but their integration into primary healthcare remains limited. OBJECTIVE: To explore Biokineticists' perspectives on their role in early NCD detection and prevention in rural South Africa, along with health-system factors affecting their integration into public primary healthcare. METHODS: An interpretivist qualitative study using semi-structured interviews was conducted with 10 purposively selected Health Professions Council of South Africa (HPCSA)-registered Biokineticists (6 female, 4 male; median age 34; median 10 years' practice experience). Interviews explored screening, health promotion, referrals, interprofessional collaboration, and systemic barriers. Sessions were recorded, transcribed, and analysed using Braun and Clarke's thematic analysis. RESULTS: Four interconnected domains were identified: (1) professional identity and recognition, (2) screening and early-detection practices, (3) community-based prevention and management, and (4) structural barriers and integration opportunities. Participants conducted screenings, exercise-based interventions, and health promotion activities, but faced fragmented referral pathways, low awareness of Biokinetics, limited visibility, and financial and geographic barriers affecting rural access. While participants viewed Biokineticists as capable contributors to NCD prevention and early detection, systemic issues, including weak integration into primary healthcare and the National Health Insurance framework (NHI), hindered continuity of care. Conclusion: Biokineticists are an underused allied-health resource with the potential to strengthen early detection and prevention of NCDs in rural primary care settings; addressing structural and policy barriers is crucial for their integration into primary care.