Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
Centre for Global Mental Health, Department of Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
PLoS One. 2022 Sep 28;17(9):e0272077. doi: 10.1371/journal.pone.0272077. eCollection 2022.
There are increasing efforts to scale up services globally for families raising children with developmental disabilities (DDs). Existing interventions, often developed in high income, Western settings, need substantial adaptation before they can be implemented in different contexts. The aim of this study was to explore perspectives on the role that context plays in the adaptation and implementation of interventions targeting caregivers of children with DDs across settings. The study question was applied to the Caregiver Skills Training (CST) programme of the World Health Organization specifically, as well as to stakeholder experiences with caregiver interventions more broadly. Two focus group discussions (FGDs; n = 15 participants) and 25 individual semi-structured interviews were conducted. Participants were caregivers of children with DDs and professionals involved in adapting or implementing the CST across five continents and different income settings. Data were analysed thematically. Four main themes were developed: 1) Setting the scene for adaptations; 2) Integrating an intervention into local public services; 3) Understanding the reality of caregivers; 4) Challenges of sustaining an intervention. Informants thought that contextual adaptations were key for the intervention to fit in locally, even more so than cultural factors. The socio-economic context of caregivers, including poverty, was highlighted as heavily affecting service access and engagement with the intervention. Competing health priorities other than DDs, financial constraints, and management of long-term collaborations were identified as barriers. This study validates the notion that attention to contextual factors is an essential part of the adaptation of caregiver interventions for children with DDs, by providing perspectives from different geographical regions. We recommend a stronger policy and research focus on contextual adaptations of interventions and addressing unmet socio-economic needs of caregivers.
全球正在加大力度扩大服务范围，为养育发育障碍儿童（DD）的家庭提供服务。现有的干预措施通常是在高收入的西方国家制定的，在不同的环境中实施之前需要进行大量的调整。本研究旨在探讨不同环境中针对 DD 儿童照顾者的干预措施的调整和实施中，背景所起的作用。该研究问题适用于世界卫生组织的照顾者技能培训（CST）方案，以及更广泛的照顾者干预措施的利益相关者经验。进行了两次焦点小组讨论（FGD；n=15 名参与者）和 25 次个人半结构化访谈。参与者是来自五个大陆和不同收入水平的 DD 儿童照顾者和参与 CST 调整或实施的专业人员。对数据进行了主题分析。制定了四个主要主题：1）适应的背景；2）将干预措施融入当地公共服务；3）了解照顾者的实际情况；4）维持干预措施的挑战。知情人认为，即使是文化因素，适应背景也是干预措施在当地适用的关键。照顾者的社会经济背景，包括贫困，被强调为严重影响服务的获取和与干预措施的参与。除 DD 以外的其他健康优先事项、财务限制以及长期合作关系的管理被确定为障碍。这项研究通过提供来自不同地理区域的观点，验证了关注背景因素是调整针对 DD 儿童的照顾者干预措施的重要组成部分的观点。我们建议更加强调政策和研究对干预措施的背景调整，以及解决照顾者未满足的社会经济需求。
