Our overall purpose was to co-develop a task-shifting approach in promote wellbeing within communities by utilising grandmothers to provide play support for children with developmental disabilities in South Africa. This study aims to understand the barriers and facilitators that impact grandmothers' engagement in this role, and assess whether play interventions delivered by grandmothers are acceptable in addressing the needs of these children and their caregivers.
We conducted individual interviews with 20 caregivers of children with developmental disabilities aged 2-12 years. Participants were recruited from both affluent (Western Cape) and disadvantaged (Eastern Cape) regions, with 10 from each province. We ensured a diverse range of perspectives by considering socioeconomic status, sex, and age of the child. The interviews explored themes such as community experiences, child and caregiver wellbeing, social support networks, engagement with their child, and the acceptability of grandmothers providing play support. Additionally, we conducted 15 semi-structured key informant interviews with community stakeholders, including community and religious leaders and grandmothers. These interviews assessed existing resources for children with developmental disabilities, as well as barriers and facilitators to delivering social interventions, and the general health and social needs of children with developmental disabilities. Data were coded according to the theoretical framework of acceptability, which consists of seven constructs: affective attitude, burden, perceived effectiveness, ethicality, intervention.
The findings suggest that caregivers and community members hold positive affective attitudes toward the potential for a play-based intervention delivered by grandmothers, viewing it as culturally relevant and promising for children with developmental disabilities. Concerns were raised about the potential burden on grandmothers, particularly regarding the time and skills required to deliver the intervention. Concerns were also raised about the number of children in a group and ability for children with participate. Participants believed the intervention could potentially improve children's social inclusion, provided it is adequately supported. Ethicality was considered, with participants emphasising the need for the intervention to align with community values and norms.
It is acceptable to deliver a play intervention with older community members. These insights will inform the development of a play intervention tailored to the needs of children with developmental disabilities and their caregivers.
By incorporating insights from caregivers, grandmothers, and community leaders, the intervention will be designed to meet the specific needs and preferences of the end users. A pilot test with six grandmothers will then assess the intervention’s feasibility. Feedback from caregivers and grandmothers will refine its content and delivery for practical, sustainable use.
child
disability
