Empowering self-help groups for caregivers of children with disabilities in Kilifi, Kenya: Impacts and their underlying mechanisms
Empowering self-help groups for caregivers of children with disabilities in Kilifi, Kenya: Impacts and their underlying mechanisms
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DOI：
10.1371/journal.pone.0229851
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发表时间：
2020-03-09
期刊：
影响因子：
3.7
通讯作者：
Hartley, Sally
中科院分区：
文献类型：
--
作者：
Bunning, Karen;Gona, Joseph K.;Hartley, Sally
在低收入环境中抚养残疾儿童面临着资源不足、心理社会支持有限和贫穷的挑战。毫不奇怪，许多照顾者感到疲劳、痛苦和孤立。为了解决和调查这些问题，采取了行动，成立了20个自助小组，重点是增强照顾者的能力。采用了一种现实主义的评价设计，以评价与自助进程有关的影响，并确定决定结果的机制。在10个月的设立期内，每月对这些团体进行监测访问，在设立期结束时，仍有11个活跃的团体，其中9个因争端、腐败和极端环境条件而解散。在六个月的时间内，向活动组（N = 154）提供了便利的干预措施。成员们在指导下审查和讨论了增强经济权能、个人情况、同伴支持、社区包容、获得保健和教育等议题。评价采用混合方法，使用问卷调查（n = 75）和半结构化访谈（n = 36）前和干预后。在基线上，孤独、挑战、耻辱和歧视是生育负担的特征。干预后，照顾者的机构被定义为团结，能力建设，接受和福祉。与照顾者的看法显着的影响，包括增加社会支持，降低儿童的残疾的严重程度和减少影响照顾者的作用的外在因素的影响。“处理货物和金钱”以及“社会关系和支持”的机制似乎是结果的基础。照顾者赋权与新开发的技能，社会联系和资源调动。记录群体进程有助于提供基于社区的包容性发展的证据。
Bringing up a child with disabilities in a low-income setting is challenged by inadequate resources, limited psycho-social support and poverty. Not surprisingly, many caregivers experience fatigue, distress and isolation. To address and investigate these issues, action was taken to set up twenty self-help groups focusing on caregiver empowerment. A realist evaluation design was adopted to evaluate impacts associated with the self-help process and to identify mechanisms determining the outcomes. Monthly monitoring visits were conducted to the groups during a ten-month set-up period, at the end of which eleven active groups remained, nine having dissolved due to disputes, corruption and extreme environmental conditions. A facilitated intervention was delivered to the active groups (N = 154) over a six-month period. The members were guided to review and discuss topics such as economic empowerment, personal situation, peer support, community inclusion, access to health and education. Evaluation employed mixed methods using questionnaires (n = 75) and semi-structured interviews (n = 36) pre- and post-intervention. At baseline, the burden of caregiving was characterised by aloneness, challenges, stigma and discrimination. Post-intervention, caregiver agency was defined by togetherness, capacity-building, acceptance and well-being. Significant impacts associated with caregiver perceptions included increased social support, reduced severity of child's disability and decreased effects of extrinsic factors affecting the caregiver's role. Mechanisms of 'handling goods and money' and 'social ties and support' appeared to underpin the outcomes. Caregiver empowerment was associated with newly developed skills, social connectedness and resource mobilisation. Documentation of group processes contributes to the evidence on community-based inclusive development.