The Rural Community-Based Occupational Therapy Model (Rural CB-OT): Community-Codesigned Solution to support Aging in Place in Rural Underserved Areas

Importance: Rural older populations experience barriers to accessing rehabilitation, occupational therapy (OT), and aging-in-place services. Access may be enhanced by service models designed by underserved communities to fit local resources and priorities. Objective: To describe the process and outcomes of a community-led codesign in rural Appalachia, Ohio, to co-create a locally tailored, community-based rehabilitation service model that supports aging in place. Design: Community-based participatory research involving a regional Steering Committee that selected a target county and codesigners. Codesigners participated in two workshops guided by a double-diamond framework and informed by rehabilitation-access maps, user personas, and evidence-based program options. Steering Committee feedback refined the model and helped identify transferable and adaptable implementation components. Setting: Medically-underserved rural Appalachia, Ohio. Participants: Seven committee members and five county-level codesigners representing public health, aging services, and community organizations. Outcomes and Measures: Community-generated rehabilitation service model and its core and adaptable implementation components. Results: Codesigners developed the Rural Community-Based Occupational Therapy (Rural CB-OT) concept, comprising six core components: community-based OT, trusted community hub, multiple service-delivery modes, task sharing, local health-system and community partnerships, and community-academic partnerships. Participants also identified context-sensitive implementation options, including team structure, population scope, hub selection, and funding. Conclusions and Relevance: Rural CB-OT offers a preliminary framework for expanding community-based OT in underserved rural communities while illustrating how evidence-informed, community-led codesign can generate locally owned rehabilitation solutions with transferable core components and adaptable implementation features. Future research should focus on further coproduction, implementation, and evaluation of Rural CB-OT and the underlying codesign approach. Plain-Language Summary: Community stakeholders in rural Appalachia used local data and evidence-informed resources to codesign Rural CB-OT, a community-based occupational therapy model intended to improve access to rehabilitation and support aging in place. Rather than selecting a single program, participants developed a flexible service framework that could support multiple rehabilitation needs while adapting to local resources and priorities.