Caregivers' and parents' explanatory models of intellectual disability in Khayelitsha, Cape Town, South Africa

Barriers to care: Caregivers' accounts of raising a child with a communication disorder

BACKGROUND

 There exists a dearth of research on the psychological experiences of childhood communication disorders. Caregivers of these children are one source who can provide us with this information since the child exists within a system. Literature on the experiences of caregivers of children with communication disorders, specifically in the South African city context, is lacking.

OBJECTIVES

 The article presents the reported experiences of six parental caregivers raising a child with a communication disorder within Johannesburg.

METHOD

 Data were collected via semi-structured interviews and underwent an interpretative phenomenological analysis.

RESULTS

 Five themes are presented: feeling out of control; barriers to accessing services; caregivers left speechless; a misunderstood disability; and relinquishing control: 'I needed to be a mommy'.

CONCLUSION

 The caregivers relayed an initially negative experience in raising a child with a communication disorder, marred with worry and fear for the future. In accessing services, they narrated their experiences of multiple barriers to access, including an overreliance on the private sector, financial barriers, time constraints, limited resources and poor information on available resources. Eventually, the caregivers were able to identify strengths, skills and capabilities within their children and themselves that allowed for adjustment and coping.Contribution: The findings highlight the importance of considering how barriers to care may marginalise and seclude parental caregivers. Over time, the caregivers were able to empower themselves through building their own knowledge and reformulating their narratives by challenging assumptions and retitling the source of disability as a product of the failure of society.

Experiences of families with children diagnosed with Autism Spectrum Disorder in World Health Organization Afro-Regions: A scoping review

A scoping review on Autism Spectrum Disorder (ASD) and its impact on the families of affected children was undertaken due to insufficient information available on the diverse experiences impacting their lives. Using the Joanna Briggs Institute methodology, eligibility criteria were guided by Population (families), Concept (family experiences), and Context (African region). English-language articles were sought from a variety of databases and search engines. The publication date of the identified articles ranged from 2003 to 2021 with most published in 2020 (n = 10), and the majority using qualitative methodologies (n = 51). Most family members involved were parents (n = 51) and their ages ranged from 18 to 75 years. The families experienced various challenges related to their child with regard to education, healthcare, and the broader community including lack of support. Family coping strategies included believing in God, attending counseling sessions, adapting, and accepting the situation. Healthcare professionals should be prepared and positioned to educate families and siblings on various aspects of ASD. There is a need for active, continued research on families within most countries of World Health Organization Afro-region.

A call to give a voice to people with intellectual disabilities in Africa through inclusive research

Research looking into the day-to-day lives of people with intellectual disabilities (ID) is on the increase in Africa. However, not enough is being done to include people with ID as active contributors to this research through inclusive approaches. Inclusive research empowers people with ID as they have the agency and autonomy to speak for themselves and they are given an active voice in the research process and outcomes. This leads to services that cater for what matters to people with ID themselves as opposed to having their needs defined by other people. The common myths and misconceptions attached to ID in Africa, which increase stigma towards people affected by this type of disability can be abated by their visibility in research and evidence of their ability to express themselves. This article makes a call to researchers on the African continent to include people with ID in research as active contributors to the research and not simply as research subjects or respondents. A background is given of global developments that have occurred in inclusive research based on the literature and the author's personal experience, which African researchers can learn from while taking cognizance of the specific needs of their own contexts. This is followed by highlighting the gaps in Africa. The article ends with a discussion of possible reasons for a lack of inclusive research in Africa and suggestions and recommendations to address this gap.

Developmental disabilities in Africa: A scientometric review

BACKGROUND

Developmental disabilities are disproportionately more investigated in higher-income countries. However, global prevalence of developmental disabilities indicate that a large proportion of individuals with disabilities reside in low- and middle-income nations.

AIMS

The present work therefore aims to conduct a scientometric review to survey available literature on developmental disabilities in low- and middle-income countries belonging to the continent of Africa.

METHODS AND PROCEDURES

A literature search was conducted on Scopus, where a total of 1720 relevant publications (and an accompanying 66 thousand references) were found, representing research conducted between 1950 to 2022. Then, document co-citation analysis was performed to chart significant co-citation relationships between relevant articles and their cited references.

OUTCOMES AND RESULTS

The generated network based on document co-citation analysis revealed a total of 14 distinct thematic research clusters and 12 significant documents that have been frequently cited in the literature on developmental disabilities in Africa.

CONCLUSIONS AND IMPLICATIONS

The scientometric review revealed a trend of broadening research towards systems of care, away from a medical model of disease. It is projected that future research will continue to capitalise on inter-disciplinary strengths to arrive at a more nuanced understanding of developmental disability from all levels - individuals, families, to communities.

Parental expectations for children with intellectual disability or autism in Ghana and Zambia: A concept mapping study

INTRODUCTION

Parent expectations have an important impact on children's outcomes. Despite a wealth of research on the familial experience of children with disabilities in African countries, very few studies have examined expectations these children's parents hold for them.

AIMS

This study explores parental expectations for children with intellectual disability, or autism and assesses their perceived importance and likelihood of attainment.

METHODS AND PROCEDURES

Concept mapping methodology with focus groups comprised of parents of children with intellectual disability or autism were employed.

OUTCOMES AND RESULTS

Results revealed several expectation themes: independence, acceptance and inclusion, public awareness, education, governmental assistance, resources, and healthcare. Whereas some expectations were congruent with themes in the broader literature, nuances within themes reflected cultural and societal conditions. Themes unique to each country also emerged, and importance and likelihood ratings revealed some cultural variation across the two countries. Expectations and the value placed on them differ across countries.

IMPLICATIONS

This study represents an important first step in efforts to understand the developmental contexts of children with disabilities on the African continent. Findings inform future research and potential strategies for policy and practice.

The design of a protocol for identifying and supporting children with developmental delays and/or disabilities in South African child and youth care centres

BACKGROUND

Historically, there is a lack of structured assessment and intervention protocols to support care of children with developmental delays and/or disabilities (DDDs) in rural child and youth care centres (CYCCs) across South Africa.

AIM

This study aimed to design an assessment and intervention protocol for holistic management of children in such centres, based on the opinions and input from CYCC staff and experts in the community.

METHODS

Data was collected in two stages, the first consisted of qualitative focus groups with CYCC staff using a semi-structured interview schedule and the second was qualitative individual interviews with experts in developmental health such as paediatricians and occupational therapists (OTs) using an interview schedule.

RESULTS

The results enabled the design of a preliminary Ecosystemic Assessment and Intervention Protocol (ECO-AIP) for children with DDDs in CYCCs that could be implemented on trial basis in further research.

CONCLUSIONS

Information relating to the identification, and care and support of children with DDDs in rural CYCCs was obtained to enable the design of the ECO-AIP. This algorithmic protocol will guide a multi-disciplinary CYCC team to identify DDDs and to assist children to reach their milestones.

African families' and caregivers' experiences of raising a child with intellectual disability: A narrative synthesis of qualitative studies

Background

The prevalence of intellectual disability was high in Africa, particularly amongst low socio-economic communities. Despite this, there was limited literature on primary caregivers and parents of people with intellectual disabilities regarding their experience raising an individual with the condition, especially within the African context.

Objectives

The aim of the current systematic review was to investigate experiences of caregivers and parents of children with intellectual disability in Africa.

Method

We used strict eligibility criteria to identify suitable studies. We identified Medical Subject Headings (MeSH) terms and other keyword terms and, after conducting searches in electronic databases, identified articles that met the inclusion criteria for articles published between 1975 and the end of 2019.

Results

164 articles were assessed for eligibility. Nine studies met the review's criteria. Six major themes emerged: understanding of intellectual disability (ID), worries about the future, burden of care, lack of services, coping strategies and stigma and discrimination.

Conclusion

Caregivers of children with intellectual disability in Africa faced substantial challenges. Current findings suggested that there was the need for both formal and alternative healthcare workers to work together towards an understanding and management of intellectual disability in Africa.

Perspectives on access and usage of assistive technology by people with intellectual disabilities in the Western Cape province of South Africa: Where to from here?

BACKGROUND

Whilst assistive technology (AT) can play an important role to improve quality of life, health inequity regarding access to appropriate AT for people with intellectual disabilities (ID) is still very much present especially in low resource countries.

OBJECTIVES

This study focused on exploring factors that influence access to and continued use of AT by people with ID in the Western Cape province of South Africa and to suggest potential implications of these findings and actions required to promote access to AT.

METHOD

A qualitative approach was used to explore the experiences of people with ID and providers of AT. Face-to-face interviews with 20 adults with mild to profound ID, and 17 providers of AT were conducted and the data were analysed thematically.

RESULTS

People with ID within the study setting faced many challenges when trying to access AT and for those who managed to acquire AT, its continued usage was influenced by both personal characteristics of the user and environmental factors. Important factors that influence AT access and use for people with ID found in this study were (1) attitudes from the community, (2) knowledge and awareness to identify AT need and (3) AT training and instructions to support the user and care network.

CONCLUSION

With the perspectives of both the providers and users of AT, this study identified priority factors, which could be addressed to improve AT access and use for people with ID in the Western Cape province.

'I Waited for It until Forever': Community Barriers to Accessing Intellectual Disability Services for Children and Their Families in Cape Town, South Africa

BACKGROUND

Intellectual disability is more common in low- and middle-income countries than in high-income countries. Stigma and discrimination have contributed to barriers to people with intellectual disability accessing healthcare. As part of a larger study on caregiving of children with intellectual disability in urban Cape Town, South Africa, we interviewed a sub-group of families who had never used the intellectual disability services available to them, or who had stopped using them.

METHODS

We employed a qualitative research design and conducted semi-structured interviews to explore the views and perspectives of parents and caregivers of children with intellectual disability who are not using specialised hospital services. We developed an interview guide to help explore caregivers' and parents' views.

RESULTS

Results revealed that caregivers and parents of children with intellectual disability did not use the intellectual disability service due to financial difficulties, fragile care networks and opportunity costs, community stigma and lack of safety, lack of faith in services and powerlessness at effecting changes and self-stigmatisation.

CONCLUSION

Current findings highlight a need for increased intervention at community level and collaboration with community-based projects to facilitate access to services, and engagement with broader issues of social exclusion.

Community participation of families of children with profound intellectual and multiple disabilities in South Africa

BACKGROUND

Families struggle to support family members with profound intellectual and multiple disabilities (PIMD), especially in low resourced settings where formal services may not be available.

METHOD

The adapted Family Community Participation survey, measuring perceptions of community participation, was administered to 67 primary caregivers of children with PIMD in Cape Town by community-based rehabilitation workers.

RESULTS

Families were most satisfied going to religious activities and getting together with family and friends. They were most dissatisfied with doing activities together in public and working or volunteering outside the home. Barriers to participation included negative attitudes, insufficient money and unavailability of community activities. Transportation, safety and security were additional challenges.

CONCLUSIONS

Participants advocate awareness raising, community support and provision of services to address barriers to community participation. Families should be consulted on community issues to integrate their specific family needs into the overall needs of the community.

The Participation of Children with Intellectual Disabilities: Including the Voices of Children and Their Caregivers in India and South Africa

There is a shortage of research on the participation of children with intellectual disabilities from middle-income countries. Also, most child assessments measure either the child’s or the caregiver’s perceptions of participation. Participation, however, is an amalgamation of both perspectives, as caregivers play a significant role in both accessing and facilitating opportunities for children’s participation. This paper reports on both perceptions—those of children with intellectual disabilities and those of their caregiver, in India and South Africa. A quantitative group comparison was conducted using the Children’s Assessment of Participation and Enjoyment (CAPE) that was translated into Bengali and four South African languages. One hundred child–caregiver dyads from India and 123 pairs from South Africa participated in the study. The results revealed interesting similarities and differences in participation patterns, both between countries and between children and their caregivers. Differences between countries were mostly related to the intensity of participation, with whom, and where participation occurred. Caregiver and child reports differed significantly regarding participation and the enjoyment of activities. This study emphasises the need for consideration of cultural differences when examining participation and suggests that a combined caregiver-and-child-reported approach may provide the broadest perspective on children’s participation.