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Perrins GL, King C, Azhdari K, Jahan I, Power R, Hashan R, Badawi N, Khandaker G. Health literacy of primary caregivers of children with cerebral palsy in low- and middle-income countries: a systematic review. BMJ Open 2025; 15:e091679. [PMID: 40032378 PMCID: PMC11877220 DOI: 10.1136/bmjopen-2024-091679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 01/09/2025] [Indexed: 03/05/2025] Open
Abstract
OBJECTIVE We aimed to synthesise existing literature on the health literacy of primary caregivers (PCGs) of children with cerebral palsy (CP) in low- and middle-income countries (LMICs). DESIGN Systematic review informed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Ovid MEDLINE, Ovid EMBASE, CINAHL via EBSCO, Scopus and Web of Science were searched from inception to January 2024. ELIGIBILITY CRITERIA Original studies including observational or experimental data, examining health literacy and/or health literacy proxies using Optimising Health Literacy and Access domains as indicators (eg, education, social support, self-efficacy, health attitudes, reading and writing skills) in primary caregivers of children with CP in LMICs. DATA EXTRACTION AND SYNTHESIS Data from included studies were systematically recorded using an Excel template, with information extracted independently by two reviewers. We used the Study Quality Assessment Tool developed by the National Health, Lung, and Blood Institute. RESULTS The systematic review yielded 2734 articles, with 15 eligible for inclusion. None used health literacy (HL) measurement tools, and there was limited reporting on specific HL domains. Studies spanned 11 LMICs across 5 major regions. PCGs, predominantly mothers, exhibited varying levels of service awareness, service utilisation and social support. Literacy levels significantly impacted HL proficiency, exposing a notable research gap in LMICs. CONCLUSIONS This study presents the first comprehensive analysis of health literacy among PCGs of children with CP in LMICs. Findings reveal a striking absence of tailored health literacy literature, impacting current considerations of PCGs' understanding and management of their child's condition. Additionally, challenges in social support, healthcare navigation and low literacy levels further hinder effective caregiving in LMICs.
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Affiliation(s)
- Genevieve Lilian Perrins
- Central Queensland Public Health Unit, Central Queensland Public Health Unit, Rockhampton, Queensland, Australia
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Catherine King
- The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Kousar Azhdari
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Israt Jahan
- Central Queensland Public Health Unit, Rockhampton, Queensland, Australia
- Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Rosalie Power
- Translational Health Research Institute, University of Western Sydney, Penrith, New South Wales, Australia
| | - Rashidul Hashan
- Central Queensland Public Health Unit, Rockhampton, Queensland, Australia
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Intensive Care, Children's Hosital at Westmead, Sydney, New South Wales, Australia
- Cerebral Palsy Alliance, Forestville, New South Wales, Australia
| | - Gulam Khandaker
- Central Queensland Public Health Unit, Rockhampton, Queensland, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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De Campos AC, Hidalgo-Robles Á, Longo E, Shrader C, Paleg G. F-words e ingredientes das intervenções precoces para crianças com paralisia cerebral não deambuladoras: uma revisão de escopo. Dev Med Child Neurol 2024; 66:e12-e22. [PMID: 37491829 DOI: 10.1111/dmcn.15717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 07/27/2023]
Abstract
Cuidados centrados na família (incluindo coaching e intervenções fornecidas pelo cuidador) e treinamento parental formal são estratégias eficazes para crianças nos níveis IV e V do GMFCS. Os ingredientes de tecnologia assistiva podem promover várias F-words (funcionalidade, saúde, família, diversão, amigos e futuro). O menor nível de evidência foi encontrado para diversão, amigos e futuro. Outros fatores (prestação de serviços, treinamento profissional, dose de terapia, modificações ambientais) são relevantes para crianças pequenas nos níveis IV e V do GMFCS. Esta revisão de escopo identificou os ingredientes de intervenções precoces para crianças com paralisia cerebral em risco de não serem deambuladoras, e os mapeou-os de acordo com a estrutura das F-words. O treinamento formal dos pais e a tecnologia assistiva se destacaram como estratégias para abordar com várias F-words.
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Affiliation(s)
| | | | - Egmar Longo
- Departamento de Fisioterapia em Pediatria, Universidade Federal da Paraíba, PB, Brasil
| | - Claire Shrader
- HMS School for Children with Cerebral Palsy, Philadelphia, PA, USA
| | - Ginny Paleg
- Montgomery County Infants and Toddlers Program, Rockville, MD, USA
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De Campos AC, Hidalgo-Robles Á, Longo E, Shrader C, Paleg G. F-words and early intervention ingredients for non-ambulant children with cerebral palsy: A scoping review. Dev Med Child Neurol 2024; 66:41-51. [PMID: 37381598 DOI: 10.1111/dmcn.15682] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/30/2023]
Abstract
AIM To explore the ingredients of early interventions provided to young children with cerebral palsy (CP) who are classified in Gross Motor Function Classification System (GMFCS) levels IV and V, and to identify the 'F-words' addressed by the interventions. METHOD Searches were completed in four electronic databases. Inclusion criteria were the original experimental studies that fitted the following PCC components: population, young children (aged 0-5 years, at least 30% of the sample) with CP and significant motor impairment (GMFCS levels IV or V, at least 30% of the sample); concept, non-surgical and non-pharmacological early intervention services measuring outcomes from any of the International Classification of Functioning, Disability and Health domains; and context, studies published from 2001 to 2021, from all settings and not limited to any specific geographical location. RESULTS Eighty-seven papers were included for review, with qualitative (n = 3), mixed-methods (n = 4), quantitative descriptive (n = 22), quantitative non-randomized (n = 39), and quantitative randomized (n = 19) designs. Fitness (n = 59), family (n = 46), and functioning (n = 33) ingredients were addressed by most experimental studies, whereas studies on fun (n = 6), friends (n = 5), and future (n = 14) were scarce. Several other factors (n = 55) related to the environment, for example, service provision, professional training, therapy dose, and environmental modifications, were also relevant. INTERPRETATION Many studies positively supported formal parent training and use of assistive technology to promote several F-words. A menu of intervention ingredients was provided, with suggestions for future research, to incorporate them into a real context within the family and clinical practice. WHAT THIS PAPER ADDS Family-centred care (including coaching and caregiver-delivered interventions) and formal parental training are effective strategies for children in GMFCS levels IV and V. Assistive technology ingredients (power, mobility, supported, sitting, stepping, and standing) may promote several 'F-words' (functioning, fitness, family, fun, friends, and future). The lowest level of evidence was found for fun, friends, and future. Other factors (service provision, professional training, therapy dose, environmental modifications) are relevant for young children in GMFCS levels IV and V.
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Affiliation(s)
- Ana Carolina De Campos
- Department of Physical Therapy, Federal University of São Carlos, São Carlos-, SP, Brazil
| | | | - Egmar Longo
- Department of Physical therapy in Pediatrics, Federal University of Paraíba, João Pessoa-, PB, Brazil
| | - Claire Shrader
- HMS School for Children with Cerebral Palsy, Philadelphia, PA, USA
| | - Ginny Paleg
- Montgomery County Infants and Toddlers Program, Rockville, MD, USA
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De Campos AC, Hidalgo-Robles Á, Longo E, Shrader C, Paleg G. F-Wörter und Interventionsinhalte in der Frühförderung nicht gehfähiger Kinder mit Cerebralparese: eine umfangreiche Literaturübersicht. Dev Med Child Neurol 2024; 66:e23-e34. [PMID: 37740649 DOI: 10.1111/dmcn.15756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023]
Abstract
AbstractZielUntersuchung der Inhalte von Frühfördermaßnahmen für Kleinkinder mit Cerebralparese (CP) mit Gross Motor Function Classification System (GMFCS) Level IV und V und die Identifikation von „F‐Wörtern“, die von den Maßnahmen adressiert werden.MethodeRecherche in vier elektronischen Datenbanken. Einschlusskriterien: experimentelle Originalstudien, die die folgenden PCC‐Komponenten erfüllten: Population: Kleinkinder (im Alter von 0–5 Jahre, mindestens 30% der Stichprobe) mit CP und erheblicher motorischer Beeinträchtigung (GMFCS‐Levels IV oder V, mindestens 30% der Stichprobe); Konzept: nicht‐chirurgische und nicht‐pharmakologische Leistungen der Frühförderung, die Ergebnisse aus einem der Bereiche der Internationalen Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF) messen; und Kontext: Studien, die zwischen 2001 und 2021 veröffentlicht wurden, in allen Konstellationen und nicht auf einen bestimmten geografischen Ort beschränkt.Ergebnisse87 Studien wurden in dieser Literaturübersicht berücksichtigt, mit qualitativen (n = 3), Mixed Methods (n = 4), quantitativ deskriptiven (n = 22), quantitativ nicht‐randomisierten (n = 39) und quantitativ randomisierten (n = 19) Designs. Die meisten experimentellen Studien befassten sich mit Fitness (n = 59), Familie (n = 46) und Funktion (n = 33), während es nur wenige Studien zu den Bereichen Spaß (n = 6), Freunde (n = 5) und Zukunft (n = 14) gab. Verschiedene Umweltfaktoren (n = 55) waren ebenfalls bedeutsam, z. B. das Angebot an Dienstleistungen, Berufsausbildung, Therapiedosis und Umweltanpassungen.InterpretationViele Studien unterstützen Elternschulungen und den Einsatz assistiver Technologien zur Förderung verschiedener F‐Wörter. Ein „Menü“ von Inhalten der Frühförderung wurden ermittelt, mit Vorschlägen für weitere Forschung, um diese in der klinischen Praxis mit Familien umzusetzen.Was dieser Artikel beiträgt
Familienzentrierte Angebote (einschließlich Beratung von und Intervention durch die Bezugspersonen) und strukturiertes Elterntraining sind wirksame Strategien für Kinder in den GMFCS‐Levels IV und V.
Hilfsmittel (Elektromobilität, unterstütztes Sitzen, Stehen und Gehen) können verschiedene „F‐Wörter“ fördern (Funktion, Fitness, Familie, Spaß, Freunde und Zukunft).
Die geringste Menge an Evidenz wurde für Spaß, Freunde und Zukunft gefunden.
Andere Faktoren (Angebot an Dienstleistungen, Berufsausbildung, Therapiedosis, Umweltanpassungen) sind relevant für Kleinkinder der GMFCS‐Levels IV und V.
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Affiliation(s)
- Ana Carolina De Campos
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | | | - Egmar Longo
- Department of Physical therapy in Pediatrics, Federal University of Paraíba, João Pessoa, PB, Brazil
| | - Claire Shrader
- HMS School for Children with Cerebral Palsy, PA, Philadelphia, USA
| | - Ginny Paleg
- Montgomery County Infants and Toddlers Program, Early Childhood Services, MD, Rockville, USA
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de Campos AC, Hidalgo-Robles Á, Longo E, Shrader C, Paleg G. F-words e ingredientes de las intervenciones tempranas dirigidas a niños no ambulantes con parálisis cerebral: Una revisión exploratoria. Dev Med Child Neurol 2024; 66:e1-e11. [PMID: 37491808 DOI: 10.1111/dmcn.15716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
La atención centrada en la familia (incluyendo coaching e intervenciones realizadas por los cuidadores) y el entrenamiento formal de los padres son estrategias efectivas para los niños con niveles IV y V de la GMFCS. Los ingredientes de la tecnología de apoyo pueden promover varias "F-words" (funcionamiento, estado físico, familia, diversión, amigos y futuro). Se encontró el nivel más bajo de evidencia para diversión, amigos y futuro. Otros factores (provisión de servicios, formación profesional, dosis de terapia, modificaciones del entorno) son relevantes para los niños pequeños con niveles IV y V de la GMFCS. Ingredientes de la intervención y F-words en intervenciones tempranas dirigidas a niños no ambulantes con parálisis cerebral.
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Affiliation(s)
- Ana Carolina de Campos
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, -SP, Brazil
| | | | - Egmar Longo
- Department of Physical therapy in Pediatrics, Federal University of Paraíba, João Pessoa, -PB, Brazil
| | - Claire Shrader
- HMS School for Children with Cerebral Palsy, Philadelphia, PA, USA
| | - Ginny Paleg
- Montgomery County Infants and Toddlers Program, Rockville, MD, USA
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Hou Y, Yan T, Deng M. A Qualitative Study on Parental Experience of Involvement in the Transition from Kindergarten to Primary School for Chinese Children with Intellectual and Developmental Disabilities. J Autism Dev Disord 2023; 53:4872-4887. [PMID: 36109470 PMCID: PMC9483495 DOI: 10.1007/s10803-022-05743-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/30/2022]
Abstract
Parental involvement plays a vital role in the transition from kindergarten to primary school among children with intellectual and developmental disabilities (IDDs); this study aims to explore Chinese parents' experiences of parental involvement during this period. Informed by interpretive phenomenological analysis, semi-structured, one-on-one interviews were held with 10 parents. Three major themes were identified: (1) "aggressive" involvement; (2) factors in transforming parental involvement; and (3) "rational" involvement. Participants reported their perceptions, attitudes, and parenting behaviors in different phases of involvement in the transition to primary school. These findings highlight the need to support parents of children with IDDs during this time of change.
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Affiliation(s)
- Yujia Hou
- Early Childhood Education College, Shanghai Normal University, Shanghai, People's Republic of China
| | - Tingrui Yan
- Special Education Department, Faculty of Education, East China Normal University, Zhongshan North Street, No.3663, 200062, Shanghai, People's Republic of China.
| | - Meng Deng
- Special Education Department, Faculty of Education, East China Normal University, Zhongshan North Street, No.3663, 200062, Shanghai, People's Republic of China
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