The meaning of participation for children in Malawi: insights from children and caregivers.
F Nelson, C Masulani-Mwale, E Richards and 2 others
PMID 27807865WHAT IT FOUND
Rural Malawian children and carers described participation as helping at home, chatting and playing.
Children with disabilities were often kept near home, not expected to do chores, and faced barriers from community attitudes and parents who denied them chances.
Key findings
01Participation for children in this setting was described mainly as helping at home, being with others and unstructured play.
02Children with disabilities were more often kept close to home, not expected to do family chores, and faced barriers from community attitudes and parents who did not give them chances.
03For children who could not speak, carers described communication through sign language or gazing and wished their child could speak.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
The study reports perceptions and themes, not tested outcomes or effects of therapy. The sample was purposive and partly drawn from a treatment centre, so it does not represent all children with disabilities in Malawi. Children attending the centre had intellectual impairment by definition, and some children were excluded because of severe communication problems or more severe intellectual disability. For some children with disabilities, carers reported activities because the child could not take part directly. Children were aged 8 to 18 years, so actions of younger children were less directly represented. Children with disabilities may have had more difficulty recalling and recounting daily activities, which could affect the number of activities reported.
Declared interests
The authors declared no conflict of interest. Dr Gladstone was supported by an NIHR Academic Clinical Lecturer award, a Wellcome Trust Biosciences fellowship and an Academy Medical Sciences Starter Grant.
The easy way to misread this
Do not read these themes as evidence that a participation intervention works or that existing measures are valid in Malawi. They describe perceptions and activities from a small purposive sample and are intended to guide later adaptation and validation.