BACKGROUND: It is estimated that 80-90% of healthcare needs can be met at the primary healthcare level. Despite their greater need for healthcare however, people with disabilities experience significant barriers to accessing primary healthcare (PHC). STUDY AIM: To use qualitative approaches to explore factors, both from the users’ and providers’ perspectives, that influence healthcare decision-making and access to primary healthcare for people with disabilities in Guatemala. METHODS: This study involved in-depth interviews and a meta synthesis of qualitative literature on barriers to access PHC for people with disabilities in Low-and Middle-Income Countries (LMIC). Interviews captured perspectives of people with disabilities (n=42) and healthcare providers and stakeholders (n=23) in three regions of Guatemala. The interviews explored healthcare decision-making, factors affecting provision of quality healthcare to people with disabilities by PHC workers, and perspectives on a Community Based Rehabilitation (CBR) pilot project focusing on improving access to PHC for people with disabilities in Santiago Atitlan, Guatemala. KEY FINDINGS: Meta-synthesis of the literature revealed three types of barriers that influence quality of interventions and access to PHC for people with disabilities: attitudinal, informational, and logistical barriers. Thematic analysis of interviews highlighted the complex decision-making process undertaken by people with disabilities about whether to seek PHC services. Stakeholder interviews revealed that healthcare providers varied in their understanding of disability which affected how they approach this population. Qualitative evaluation of the pilot CBR program demonstrated that while there may be challenges to implementing CBR, it has the potential to respond to some of the barriers experienced by both people with disabilities and healthcare providers impacting access to PHC. CONCLUSION: People with disabilities face a myriad of barriers in accessing PHC services within their communities in Guatemala. These barriers are further influenced by their intersectionalities and conceptualizations of disability in Guatemala impacting their decision-making in seeking services. Improving access and utilization of PHC for this population needs to include interventions that address the needs of people with disabilities as service users as well as healthcare providers. Community engagement initiatives such as those implemented through CBR strategies can improve access to primary healthcare for adults with disabilities by addressing misconceptions about disability through community education and training as well as establishing trust.