The duration of the interview sessions was meant to last for between 30 to 45 minutes. There were 40 caregivers of children with CP who participated in the study with mean age, 27.17±4.46 years. The details of the demographic characteristics of the study participants including mean age of the children, occupation of their caregivers, level education of the caregivers and the children and sex are presented in table 1.
Following the transcription and coding of the data obtained from the qualitative interview, several themes were generated for both the facilitators and the barriers. For the facilitators, there are improvements in the child’s condition, family support, improvements in the condition of other children with CP, empathy, encouragement by the therapist managing the child and cooperation of the child during home program. For the barriers, there are number of children the caregiver has, caregiver’s occupation and inadequate financial resources. Figure 1 summarizes the barriers and the facilitators.
The Barriers
Theme 1: Number of children
The number of children a caregiver has, may impact on the kind of attention she may give to the child with CP. In this society, women usually give birth to many children. In this study, the range of number of children is 6.
“I have other children in addition to this one and they are all young. Thus, they always need my attention, and this makes me some times to delay his home programs”…………….Participant number 6.
“As I have told you earlier her mother has died since when she was 3 month; and as you can see me too I have my own baby who is her age mate. But, I have no alternative other than to take her as there is no one to take good care of her other than me as her aunt”…………….participant number 15.
“As now she have a younger sister so sometimes I have no choice other than to concentrate on her younger sister especially when she is crying and that makes me to skip some of the activities prescribed for her by the therapist”……………….Participant number 38.
Theme 2: Caregiver’s Occupation
Caregiver’s occupation can take some parts of their time, and thus can interfere with the amount of attention they give to the children. Most women in this society are full time housewives with no occupation.
“I used to sell groundnut and palm oil in my house. So, sometimes customers used to distract my attention from her, but I have no option as the business too is important to our life”……………….Participant number 5.
“I am a class room teacher in a primary school. Whenever I am having a class, I used to leave her with a girl that is assisting me in our staff room and sometimes she used to cry before I finish teaching my student”………………Participant number 34.
“I am working in secretariat and whenever I left for work, there is a girl that is taking care of her. But I know she cannot do it as appropriately as I am doing”………………Participant number 31.
Theme 3: Lack of Financial Resources
Financial resources are adequately required during rehabilitation especially where payments are made out pocket. However, in this community, most people live on under a dollar per day.23
“Three months ago, the Physiotherapist asked us to buy some equipment that we will be using for him at home (for home program). But up to now, we did not buy some of them because of financial issues; but as soon as we get money we will buy the rest of the equipment”………………..Participant number 19.
The Facilitators
Theme 1: Improvement in the Child’s Condition
What makes the caregivers to bring their children for rehabilitation is hope for help. Therefore, when they observe that their children are getting proper help and may be improving, they will be motivated to put more efforts.
“The time we started attending physiotherapy, my child cannot even sit but now he can stand and even walk a few steps. So this motivates me to carry out the activities that the Physiotherapists asked us to do for him at home”……………….Participant number 4.
“It is really encouraging as within the few weeks that my child started receiving Physiotherapy treatment, he can sit for like 3-5 minutes unsupported. He could not sit at the time we first came.”…………Participant number 13.
“It is really impressive that within 5 months of treatment my son can now sit and I am confident that by God grace, one day he will walk and even run like his age mates. That is why I never play with the activities that the therapist asked me to do for him at home”……..Participant number 17.
Theme 2: Family Support
Help from family members can help reduce stress for the caregivers; and make them recharge and prepare to look after their children.
“Whenever we are asked to use some equipments that will help in the improvement for my child condition, my husband is trying his best to provide such equipments, and whenever he is at home like weekend he used to help me with some home activities like washing clothes. So this is giving me enough time to take care of my child”……………….Participant number 3.
“My first daughter is now 18 years old and the second one is 15 years old. Whenever they are at home, they are the ones doing most of the home activities like cooking, and sweeping. So what remains for me is just to take care of my child”……………….Participant number 17. “Since the time the Doctor told us that our child is having this condition, my husband employed a girl who is helping me with some work at home. So, this motivates me to utilize my time for taking care of my child”………………..Participant number 39.
Theme 3: Improvement in the Condition of other Children with CP
Seeing other children with CP who may even have more number deficits than one’s child, may help caregivers to tighten their belts as per as the care for their children is concerned.
“I have been seeing so many children that their condition is worse than that of my child, but as they are attending clinic, their condition is improving. Thus, I am confident that my child will get better. That is why I am taking my time to do the activities that the therapist asked me to do for him.”………………Participant number 33.
“My neighbor has a son that has experienced the same condition with my daughter. But now, he is even attending school. So, that is why I have courage that, with time my daughter too will get to that stage. So that is why I don’t joke with anything the therapist says I should do for her”………………Participant number 13.
Theme 4: Encouragement from the Therapist Managing the Child
Encouragements from the therapists are needed in order to boost the morale of the caregivers.
“Before, my perception was my son will never walk like the other children. But the therapist managing him keep encouraging me that one day my child will even run, and he kept citing many examples to me. So those words of his motivate me to concentrate on my child more than anything”………………Participant number 35.
Theme 5: Empathy
“The rest of my children can perform some of their activities of daily living by themselves, but this child cannot do anything by himself. So this makes me to pity him and pay more attention in taking care of him”……………Participant number 30.
Theme 6: Co-operation of the Child during the Home Program
The way the child cooperates during the time of rehabilitation by the caregiver at home, can make an opportune time for the caregiver to devote their effort in the rehabilitation.
“Whenever I am doing the exercises for her at home, she will not be crying as some of the children are doing. So this is encouraging me to do the exercises for her comfortably without difficulties”……………Participant number 31.
“My child found most of the exercises enjoyable especially the rollator. So, whenever I am doing the exercise for him he doesn’t even want me to stop. So this is motivating me to do it well for him as he is enjoying it”…………….Participant number 36.
“As my child is co-operating during the exercises- nothing like crying, I find it encouraging; and enjoyable to do the exercises for her”………………Participant number 7.