Caregivers' experiences of having a child with cerebral palsy. A meta-synthesis

AIM

To synthesize qualitative research findings of caregiver experiences and challenges in caring for and raising a child with cerebral palsy.

DESIGN

A systematic review and meta-synthesis.

METHODS

Four electronic databases: CINAHL, Embase, OVID Medline, and Cochrane, were systematically searched for qualitative research papers published before December 2022. Two independent reviewers assessed eligibility and further appraised the quality of methodology using the Critical Appraisal Skills Program (CASP) tool for qualitative research. A content thematic analysis approach was used to synthesize the qualitative research findings, construct core subthemes, and synthesize themes.

RESULTS

Sixty-seven findings were extracted from the 12 included studies. The findings were grouped into eleven sub-themes and then into five synthesized themes. The synthesized themes are 1. Need for convenient healthcare facilities, therapeutic services, and accessible public places, 2. Need for healthcare information and financial aid, 3. Psychological, and physical constraints, 4. Societal rejection and stigma, and 5. Overwhelming caring burden.

CONCLUSION

Caregivers face many challenges in adjusting their lifestyles to meet the needs of the child with cerebral palsy. Some adjustments reported included giving up full-time jobs and businesses to be full-time caregivers, giving up leisure activities, and confinement to one place.

A scoping review on occupational science research in European contexts

BACKGROUND

A survey showed European occupational scientists cover a broad range in occupational science (OS) research, however, no contemporary overviews of European OS research exists, and current research may provide valuable information for OS and occupational therapy.

AIM

The aim was to provide an overview of contemporary European OS research.

MATERIALS AND METHOD

A scoping review was performed, including studies conducted in Europe and published in the British Journal of Occupational Therapy (BJOT), the Scandinavian Journal of Occupational Therapy (SJOT) or the Journal of Occupational Science (JOS) between 2015 and 2020. The journals were systematically searched, and quality assessment and thematic analysis were undertaken.

RESULTS

Findings from 93 articles identified many studies from the Nordic countries. Most studies applied qualitative research methods. Theoretical concepts from OS were used in data generating and discussions. A wide range of demographics, and living conditions were explored. Recent articles took a reflexive stance on the positionality of the researcher/s.

CONCLUSIONS

This review highlights the diversity of OS research, suggesting a solid theoretical knowledge base within European OS research.

SIGNIFICANCE

The results contribute to further development and maturation of the discipline of OS in Europe and internationally.

Healthy Mothers Healthy Families, Health Promoting Activity Coaching for mothers of children with a disability: Exploring mothers' perspectives of programme feasibility

BACKGROUND

Health Promoting Activity Coaching, an intervention within the Healthy Mothers Healthy Families programme (HMHF-HPAC), was delivered by occupational therapists in a project that assessed feasibility of this new intervention. The HMHF-HPAC promotes the health and well-being of mothers of children with disabilities and is a six-session programme with website, workbook, and one-on-one coaching. Consumer experiences of this novel health-promoting intervention were sought to enable consumer-informed feedback for future modifications and improvements prior to further development.

METHODS

This qualitative study explored the experiences of mothers who participated in the HMHF-HPAC and their perspectives on the service delivery, content and impact. This study was embedded within an overarching feasibility study and was conducted parallel to a quantitative component. Seven mothers who completed the HMHF-HPAC participated in semi-structured interviews. Data were analysed thematically using a six-stage thematic approach.

FINDINGS

Four key themes emerged: Recognising Mothers; From Vulnerability to Empowerment; A Goal for Me; and Perspectives on Content and Delivery. Mothers reported increased participation in health-promoting activities over the duration of HMHF-HPAC, reflective of their individual needs. Mothers described improved mood and energy levels, reduced stress and anxiety, greater self-awareness, and increased engagement in leisure activities with their children. Health-promoting goals identified by mothers' pertained to improving physical activity levels, healthy dietary changes, sleep quality and duration, community engagement, and mindfulness activities. Mothers reported that their child's occupational therapists, the website, and workbook were acceptable and viable.

CONCLUSIONS

Mothers' experiences support the feasibility of embedding the HMHF-HPAC programme into occupational therapy services directed towards child and family-focused interventions. Mothers found occupational therapists to be acceptable facilitators of the HMHF-HPAC, given the frequent interactions and rapport with mothers and the occupational underpinnings of the programme. The HMHF-HPAC is an accessible intervention that promotes family-oriented practice.

Development of the International Spinal Cord Injury Basic Data Set for informal caregivers

Study design

Mixed-methods, including expert consensus for initial development and a multi-center repeated measures design for field testing.

Objectives

To develop an International Spinal Cord Injury Basic Data Set for caregivers of individuals with spinal cord injury/disorder (SCI/D) for use in research and clinical care settings.

Setting

International, multi-disciplinary working group with field testing in five North American pediatric rehabilitation hospitals.

Methods

The data set was developed iteratively through meetings and online surveys with a working group of experts in pediatric and adult SCI/D rehabilitation and caregivers of individuals with SCI/D. Initial reliability was examined through repeat administration of a beta form with a sample of caregivers recruited by convenience. The sample was characterized with descriptive statistics. Intra-rater reliability of variables was assessed using Intra-Class Correlations.

Results

The beta test form included 27 items, covering 3 domains: (1) demographic information for persons providing care; (2) caregiver’s allocation of time and satisfaction; and (3) perceived burden of caregiving. Thirty-nine caregivers completed both administrations. Mean time for completion was 10 min. There was moderate to excellent reliability for the majority of variables, but results indicated necessary revisions to improve reliability and decrease respondent burden. The final version of the data form contains 7 items and is intended for self-administration among informal caregivers of individuals with SCI/D across the lifespan.

Conclusions

The International SCI Basic Data Set for Informal Caregivers can be used to standardize data collection and reporting about informal caregivers for individuals with SCI/D to advance our understanding of this population and the data form has additional utility to screen for caregiver needs in clinical settings.

Further psychometric evaluation of the My Family's Accessibility and Community Engagement (My FACE) tool: Mothers' ratings of perceptions of community accessibility and engagement for their child with disabilities

BACKGROUND/AIM

My Family's Accessibility and Community Engagement (My FACE) measures mothers' perceptions of community accessibility and engagement for families raising children with a disability. This study investigated the construct validity including the factor structure and internal reliability of the MyFace scale.

METHODS

Construct validity was evaluated using hypothesis testing. Structural validity was confirmed with factor analysis. Internal reliability was measured using Cronbach alpha. The nine-item MyFACE includes items representing common community destinations. A 5-point Likert scale measured perceptions of need for change and inclusion.

RESULTS

Mothers (N = 83) completed an online survey with MyFACE, maternal and childhood disability scales. Hypothesis testing revealed correlations with MyFACE: Depression Anxiety Stress Scales (DASS)-stress (r = -.25, n = 72, p = .037), DASS-anxiety (r = -.41, n = 70, p < .001,), and DASS-depression (r = -.27, n = 72, p = .023,) scales. MyFACE scores correlated with mothers' total Health Promoting Activity Scale (HPAS) scores (r = .40, n = 74, p < .001). HPAS was the strongest predictor of variation in MyFACE scores F(5, 66) = 5.68, p < .001. Factor analysis demonstrated unidimensionality. Internal reliability was excellent (Cronbach alpha = .80).

CONCLUSIONS

The MyFACE tool is psychometrically sound. Compared to child factors, maternal mental health and health promoting behaviour had more influence on mothers' perceptions of family community accessibility and engagement. The MyFACE measures a unique, previously unmeasurable family construct.

Exploring the process of health in mothers of children with cerebral palsy: Changing “clinical reasoning”

Introduction

The issue of the health status of mothers of children with disability is one that is beginning to be addressed more fully. This study aimed to explore the process of health in mothers during caregiving of children with cerebral palsy (CP).

Method

A qualitative research method with a grounded theory approach was used, including purposive and theoretical sampling. A constant comparative analysis method was adopted, and data were gathered from 15 mothers with CP children through interviews.

Results

The results were grouped into six main categories: Self-neglecting of their health, facing challenges in caring their children, physical and psychosocial damages, perceiving threat of health problems from concern to action, trying to regain their health, and caring in a complex context. “Facing challenges in caring” was extracted as a core concept.

Conclusion

Results showed an urgent need to establish family-centered services in clinical settings and change the “way of thinking” of the health provider system.

Occupational balance and quality of life in mothers of children with cerebral palsy

Introduction

Occupational balance (OB) is an important concept in occupational therapy and is considered as an essential component of health and well-being. The aim of this study was to show differences in OB and quality of life (QoL) between mothers of children with cerebral palsy (CP) and typically developing children.

Methods

Thirty-six mothers of children with CP and 36 mothers of typically developing children participated in the study. The mothers’ OB was evaluated using the Turkish Occupational Balance Questionnaire-11 (OBQ11-T), and their QoL was evaluated with the Nottingham Health Profile (NHP).

Results

The OBQ11-T, total score, and the item ‘balance between obligatory and voluntary occupations’ score differed significantly between the groups ( p < 0.05). There were also significant differences in NHP’s aspects of emotional reaction, social isolation, and sleep scores between the groups ( p < 0.05). A negative correlation was detected between OBQ11-T total and NHP total scores in mothers of children with CP ( p < 0.01).

Conclusion

This study demonstrates that occupational therapists should pay attention to balance between obligatory and voluntary occupations to promote occupational balance. Also, QoL in mothers of children with CP should be evaluated. Therefore, occupational therapists should implement interventions to increase them when necessary for mothers of children with CP.

Predictors of mental health among parents of children with cerebral palsy during the COVID-19 pandemic in Iran: A web-based cross-sectional study

BACKGROUND

Caring for children with cerebral palsy (CP) for many aspects of their lives may affect caregiver's psychological health. Emergence of COVID-19 put added pressure on caregivers.

AIMS

The aim of this study was to investigate the psychological health of Iranian caregivers of children with CP and associated risks during a lockdown period.

METHODS

Using online snowball sampling, 160 caregivers of children with CP participated in this web-based cross-sectional study. The Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS-4), Caregiver Difficulties Scale (CDS), and a demographic questionnaire were administered. Hierarchical multiple linear regression analysis was applied to identify risk factors related to caregiver psychological health.

OUTCOMES AND RESULTS

Mental health problems were prevalent; (depression = 45.0% and anxiety = 40.6%). Significant correlations were found between CDS and HADS-Anxiety (r = 0.472, P < 0.001), HADS-depression (r = 0.513, P < 0.001), and perceived stress (PSS) related to COVID-19 (r = 0.425, P < 0.001). After controlling for demographic and clinical variables, burden (CDS) was found to significantly predict caregiver anxiety, depression and stress. Furthermore, several demographic characteristics (being married, low educational level and low income) were significantly related to high HADS Anxiety scores. For depression, only having a physical problem was significantly related to HADS among demographic variables. No significant correlations were found between PSS-4 and demographic variables.

CONCLUSIONS AND IMPLICATIONS

During COVID-19 outbreak, the mental health of caregivers of children with CP is affected by multiple factors such as burden of care and demographic characteristics. Due to the importance of well-being among caregivers of disabled children, a comprehensive plan including psychological consultation, remote education, or in-person handouts for the self-care or handling of the children and adequate distance support may enable better mental health for these caregivers.

Experiences and Needs of Parents Caring for Children with Cerebral Palsy: A Systematic Review

OBJECTIVE

Caregiver burden of parents of children with disabilities is negatively associated with parental quality of life and psychosocial well-being and has been identified as a public health concern. Reviews have consolidated the experiences of these parents, but little is understood about the unique challenges faced by parents of children with cerebral palsy (CP). We aim to conduct an in-depth synthesis of the experiences and needs of parents of children with CP to better support them.

METHODS

Six electronic databases were searched systematically for qualitative research, and a thematic synthesis was performed.

RESULTS

Seventeen studies from 1988 to 2019 encapsulating the experiences of 226 parents were included in this review. Four themes and 11 subthemes were identified: (1) self: the caregiver-parent trajectory (coming to terms with the fact, physical and emotional demands, and a nice outlet), (2) family: maintaining the family unit (juggling multiple children and parenting as a co-occupation), (3) society: social repercussions (facing public discrimination, rejection by extended family, and loss of freedom), and (4) parents' wish list (open communication and caring attitudes, funding and health care accessibility, social integration, and inclusivity). Apart from emotional adaptation and physical childcare difficulty, parents indicated a need for more information on health care services, funding, better attitudes and empathy from health care providers, properly trained educators, disability-friendly fixtures, and more public awareness.

CONCLUSION

The findings in this review provide insight into the true experiences and needs of parents caring for children with CP and will aid clinicians in the development of family-centered care pathways for these patients.

Occupational patterns of families living with a health condition: A scoping review

BACKGROUND

A family's health is sustained by its occupational patterns. While it is commonly accepted that a health condition places extra demands on a family's time or can limit daily occupations, few studies have reported on the occupational patterns of these families.

AIMS/OBJECTIVES

This scoping review provides an overview of the current state of research exploring occupational patterns of families living with a health condition.

MATERIAL AND METHOD

Publications between 2000 and 2018 indexed in CINAHL, PsycInfo, Medline and Scopus databases were searched.

RESULTS

Seventy-seven studies were included in the final content analysis. Findings suggest that families' occupational patterns are more complex than simply the sum of individual and shared occupational patterns, but consist of interconnected relational aspects of occupations, rarely highlighted in studies. Moreover, testimonies tend to be predominantly from the mother's perspectives, thereby limiting the scope of understanding of the interdependent nature of families' occupational patterns.

CONCLUSION

To better understand the complexity and interdependence of families' occupational patterns, future studies should examine multiple perspectives (parents and children) when studying occupations in a family setting. This can be enabled by the use of a variety of data collection methodologies.

A Qualitative Study of Caregiving for Adolescents and Young Adults With Spinal Cord Injuries: Lessons From Lived Experiences

Objective: To examine characteristics of caregiving from the perspectives of adolescents and young adults (AYAs) with spinal cord injuries (SCIs) and their informal caregivers to address outstanding gaps in knowledge relating to definitions of caregiving and its associated practices for this population. Methods: A multiphase qualitative design was applied, using phenomenological and narrative methods to capture data in participants' homes and communities. Participants were recruited from rehabilitation hospitals and community organizations throughout Los Angeles County, California. Inclusion criteria for AYAs included being 15-22 years old, having acquired an SCI within the previous 5 years, and using a wheelchair for mobility. The AYAs nominated persons they identified as primary caregivers to also participate. Data were collected through individual and group interviews as well as activity observations. Results: Data from the 17 participants (9 AYAs and 8 informal, primary caregivers) revealed ways in which the meaning of caregiving varied among dyads. Caregiving practices extended beyond physical assistance to include support for a range of day-to-day activities spanning from practical needs to facilitating developmental trajectories. Although AYAs expressed ideas about preferred caregiver characteristics, care partnerships appeared to be guided more by availability than preference. Conclusion: Phenomenological analysis revealed that the meaning of "caregiving" and its associated practices are highly individualized for AYAs with SCIs. Caregiving is rooted in personal needs related to effects of SCI and developmental goals. Everyday practices are shaped by individual relationships and the beliefs of AYAs and their caregivers. Addressing influences of caregiving on long-term health and function may require attention to developmental processes, caregiver "fit," and ways care is, or can be, distributed throughout broader networks according to personal needs and preferences.