Published in PLOS One on 2026-09-01, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Takondwa Connis Bakuwa, Gillian Saloojee, Wiedaad Slemming
Source: PLOS One • DOI 10.1371/journal.pone.0356240
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
The implementation of caregiver-led training programmes for complex childhood-onset conditions like cerebral palsy is challenging as multiple factors influence outcomes, particularly in rural, resource-constrained settings. Understanding the perspectives of the caregivers and professionals implementing programmes is important to identify practical, cultural, and logistical factors that influence programme outcomes. This qualitative study explored the facilitators and barriers encountered during the implementation of a caregiver-led training programme in rural Mangochi, Malawi.
In-depth interviews were conducted with physiotherapists and caregivers of children with cerebral palsy who participated in a seven-week feasibility trial of the Malamulele Onward Carer-2-Carer Training programme in August 2023. Semi-structured interview guides informed by the Consolidated Framework for Implementation Research were used to conduct the interviews. The interviews were audio-recorded and transcribed verbatim. Data were managed using NVivo and analysed thematically. An abductive analytical approach was used, whereby themes were initially generated inductively and later interpreted deductively within the framework to enhance conceptual depth.
Facilitators of programme implementation included the integration of training into daily caregiving routines, active caregiver engagement, and the logistical support provided by a community-based organisation. A key finding was the unique contribution of expert caregivers, who facilitated sessions using shared language, lived experience, and emotional connection, which enhanced caregiver participation and trust. The expert caregivers’ ability to mobilise local resources further supported programme delivery. Barriers included time constraints for covering some modules, slow learning and particular skill acquisition challenges among older caregivers and external factors such as poor access to transportation and limited family support for home practice. While both expert caregivers and therapists effectively facilitated the programme, expert caregivers encountered occasional challenges with content presentation when delivering sessions.
Reflections from caregivers and physiotherapists in rural Malawi highlighted the strengths of integrating lived experience into programme delivery. Expert caregivers fostered engagement and trust, helping to address participant learning challenges. However, continued mentorship, improving physical access and social support remain crucial for sustaining caregiver-led training programmes and maximising their impact on children with cerebral palsy and their families.
Introduction
Cerebral palsy (CP) is the most common motor disability in children. Daily living is demanding for children and their families due to the lifelong activity and participation restrictions they face [1–3]. Caring for a child with CP in Low- and Middle-Income Countries (LMICs), such as rural Malawi, is particularly difficult, given the limited access to specialised healthcare, supportive services, and rehabilitation [1]. Caregivers, usually family members, are the primary providers of care and support for children with CP [4], a role and responsibility for which many feel unprepared. Caregiver strain, stress, fatigue, depression, and ultimately a reduced quality of life, are well-documented in the literature [1,5–8]. In addition, the high levels of poverty, stigma, and negative attitudes that caregivers living in LMICs face highlight both the pressures and the high levels of resilience that they need to demonstrate to sustain caregiving.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Takondwa Connis Bakuwa, Gillian Saloojee, Wiedaad Slemming. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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