Community-based rehabilitation (CBR) has been widely adopted as a strategy to enhance the quality of life for people living with disabilities (PWD) by integrating health, education, social inclusion, empowerment and livelihood (Blose et al. 2021). The CBR matrix, which outlines these five pillars, provides a robust framework for guiding interventions. However, the application of this matrix in evaluating CBR interventions remains a challenge, as PWD continue to face entrenched issues such as poverty and human rights violations (Blose et al. 2021). While the matrix offers a comprehensive approach, its implementation must be flexible enough to adapt to different contexts, as the relative importance of each pillar may vary depending on the specific goals of the intervention and the population served.

Despite the advancement of the CBR matrix to guide CBR interventions to provide a comprehensive service, PWD remain in a poverty cycle and experience a gross infringement on their human rights (Blose et al. 2021). Limitations exist in evaluating CBR, as no consensus has been reached on the most appropriate tools or generic outcome measures when evaluating CBR interventions. Appropriate evaluation processes allow services to improve by exposing strengths and weaknesses.

The World Health Organization (WHO) has long defined ‘disability’ as an umbrella term encompassing impairments, activity limitations and participation restrictions (WHO 2011), which arise from the interaction between a person with a health condition and environmental and personal factors. Over a billion people are estimated to live with some form of disability, and the rates of disability continue to increase, partly because of ageing populations and the rising prevalence of chronic health conditions (WHO 2019). Historically, disability has been viewed through a deficit-based lens; however, in 2023, the WHO adopted the concept of Positive Health, emphasising well-being as a dynamic ability to adapt and manage life’s challenges (Van Vliet et al. 2024). This shift significantly impacts the way disability prevalence is understood and counted, as it expands the scope beyond mere impairments to include an individual’s capacity to thrive within their context. Community-based rehabilitation aligns well with this framework, as it promotes social inclusion, empowerment and functional ability rather than solely focusing on medical limitations. Recognising disability within this broader construct reinforces the need for robust, context-specific CBR methodologies that support both individuals and their communities (Mason et al. 2017).

In low-middle-income countries (LMICs), PWD are often unable to contribute to the household income and are dependent on family members for daily tasks. A lack of independence for PWD has a negative impact on the national economy and health care structures as there is a growing demand for government financial aid and health resources.

Global rural population has reached 3.4 billion with close to 90% of the world’s rural population living in Africa and Asia (International Labor Office 2018). The rural population of the world has grown slowly since 1950 and is expected to reach 3.1 billion by 2050 (International Labor Office 2018). Already, access to health care is very challenging for persons living in rural areas, and a predicted increase in population size will place further strain on existing social services.

The global population size is on the increase, and with it, the number of PWD (International Labor Office 2018). People living with disabilities face various barriers within their communities, particularly those related to accessing medical services, especially in low-income or rural areas. Community-based rehabilitation is the most effective approach for improving the well-being of PWD and fostering increased community participation in these settings. However, there is currently no consensus or framework for evaluating the impact of CBR interventions, limiting their uptake into policy (Thomas & Thomas 1999).

Accessing medical services is vital for PWD to promote health, prevent deterioration, improve overall function and community participation and strive for the optimal quality of life (WHO 2010). A consensus evaluation framework can contribute to the effectiveness and sustainability of CBR interventions, ultimately improving the well-being and participation of those living with disabilities, particularly in rural and low-income areas.

There is a sense of urgency for the development of research and, more specifically, a framework that stands to evaluate interventions. Boyce and Ballantyne (2000) argue that evaluating CBR interventions is often not a priority for project leaders but emphasise that CBR cannot be sustained without appropriate evaluation mechanisms to assess its foundational information base. Furthermore, they believe that evaluation, if appropriately conducted, can help the development of community programmes. Quantifiable evidence is essential for informing policy decisions. Without it, there is no objective basis for advocating national or international change at the governmental level.

The following research question guided the review:

‘What are the existing frameworks or models that have been used to evaluate CBR interventions?’ and ‘How usable and relevant are these frameworks to the context of CBR?’

The objective was to explore theoretical frameworks used in evaluating CBR interventions, assessing their suitability, context-specific applicability and cultural relevance.

This scoping review was conducted in accordance with the ethical standards outlined by the University of the Western Cape’s Biomedical Research Ethics Committee. Permission to conduct this research was obtained from the Biomedical Research Ethics Committee (Reference number: BM20/5/31).

Most of the publications used a case study approach to conduct their study in low-income communities in Africa and Asia (Adeoye, Seeley & Hartley 2011; Biggerri & Ferrannini 2014; Chung et al. 2011; Luruli et al. 2016). The remaining publications either represented an online community or a high-income country, such as the United Kingdom (Scobbie et al. 2013). The case studies were mostly focused on the framework or concept in question and how it interacted with the setting and community.

The studies by Grandisson et al. (2016) and Velema and Cornielje (2003) had a broader focus on available literature and creating concepts and suggested frameworks to be used in a CBR context (see Table 2).

None of the studies identified a single framework applicable to all CBR interventions (Table 3). This likely reflects the diverse and context-specific nature of CBR interventions, which necessitate tailored evaluation frameworks. Instead, most of the case studies utilised a combination of established white paper literature (such as the CBR matrix and CBR guidelines) and the institution’s own documentation to create a unique, context-specific framework for evaluating the specific programmes under investigation.

Only one study deviated from this approach, focusing on an existing evaluation method known as the Goal Setting and Action Planning (G-AP) framework (Scobbie et al. 2013). The G-AP framework is designed to evaluate complex interventions through goal setting and action-planning principles. It employs action plans and coping strategies to achieve outlined goals and overcome anticipated barriers. An intervention’s success is measured by the achievement of these goals.

Velema and Cornielje (2003) advocate for a reflective approach before commencing evaluations. They emphasise the importance of a solid foundation where systematic information is gathered about the individual, services, programme, programme environment and the interrelationships between these elements. Their study introduced a sequential question framework designed to stimulate critical thinking and define the evaluation’s purpose before it begins.

The Delphi study conducted by Grandisson et al. (2016) involved 42 experts in CBR to determine the best evaluative practices. The consensus among experts was that the most suitable framework for evaluation would be a combination of the CBR matrix and the guiding principles of CBR. The major pillars of the CBR matrix – Health, Education, Social, Livelihood and Empowerment – provide a structured framework for evaluations, ensuring they remain context-specific and culturally respectful.

Although this review attempts to uncover literature on frameworks used to evaluate CBR interventions, several limitations are acknowledged. The date range of published literature was restricted to 2000–2020, excluding research done before or after this period. The search only included English publications, excluding potentially relevant studies from non-English speaking low-income and middle-income countries where CBR is more commonly implemented. Only full-text articles published in peer-reviewed journals were included, omitting grey literature that could provide additional insights.