Rehabilitation for children with cerebral palsy in a lower-middle income country: A qualitative phenomenological
Stewart Drew1,2, Shafiul Islam2,3, Israt Jahan2,3,4
1Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
Aim:
To examine the persistent barriers and facilitators to rehabilitation uptake among children with cerebral palsy (CP) in rural Bangladesh, with focus on engagement in therapy and self-management, and beyond the context of attendance.
Method:
This qualitative phenomenological study was conducted in four subdistricts of Sirajganj, Bangladesh. In-depth interviews were conducted with caregivers of children with CP registered in the Bangladesh CP Register and rehabilitation professionals recruited purposively from Sustainable Model of eARly intervention and Telerehabilitation for children with Cerebral Palsy (SMART-CP) centres. Interviews were transcribed, translated, and analysed thematically using an inductive approach.
Results:
Between November and December 2022, 45 caregivers and eight rehabilitation professionals were interviewed. Three key themes emerged: (1) financial and logistical resources, including poverty, transport difficulties, and competing demands; (2) emotional burden, intensified by social stigma and negative family attitudes, and caregiver loss of hope in adequately supporting their child; (3) self-efficacy, where caregiver education, coaching, and belief in therapy facilitated engagement. Local, affordable services, family and peer support, and community awareness further enabled rehabilitation uptake, which varied across families and over time.
Interpretation:
Children with CP and their caregivers in rural Bangladesh face persistent barriers to accessing rehabilitation. Interventions that enhance local service provision, staff training, and caregiver support may improve rehabilitation engagement and health outcomes. Enhanced livelihood support and expanded training opportunities may further strengthen rehabilitation uptake.
