Group-based caregiver support interventions for children living with disabilities in low-and-middle-income countries: Narrative review and analysis of content, outcomes, and implementation factors

Abstract

Background Caregivers of children with disabilities in low-and-middle-income countries (LMICs) face unique demands and challenges. Group education and support interventions can benefit parental and child well-being, however there is limited data from LMIC settings. Methods We systematically searched databases (Medline, Embase, PsycINFO) for English language publications reporting on group-education and support-interventions for caregivers of children living with disability in LMICs, published between April 2012 and April 2022 using pre-established inclusion and exclusion criteria. Data from included studies was extracted and descriptively analysed in an online form, covering population, intervention, outcomes, and factors affecting implementation with key findings reported using narrative synthesis. Results Of 1557 studies identified, 31 studies were included for full text review. The majority of these were qualitative (n=15, 48%) and from middle-income countries (n = 26, 83.9%). A minority of studies were conducted in low-income-countries (n=4, 12.9%). Recurring themes in caregiver support-intervention content include child behavioural management (n=17, 54.8%) and child activities-of-daily-living (n=16, 51.6%). Almost all interventions were facilitated by non-specialists (n=23, 74.2%). Interventions mostly employed active learning strategies, including group discussion (n=17, 54.8%) and hands on activities (n=11, 35.5%). Outcomes across studies suggest interventions have the potential to improve many aspects of caregiver and child functioning. Major barriers to intervention implementation included lack of caregiver support from family members, time constraints on caregivers and poverty. The social support networks and education regarding childhood disability in a broader social context provided to caregivers during support group interventions reduce the social isolation and stigma experienced by caregivers of children living with disability in LMICs. Relevant appropriately targeted intervention content and supportive facilitators contributed to caregiver satisfaction toward support interventions. Caregiver support group interventions established in LMICs should prioritise sustainability through building strong partnerships with government and nonfor-profit organisations. Conclusions Caregiver support group interventions provide a promising avenue of improving caregiver and child outcomes for children living with disability in LMIC settings. More research is needed in this area.