Caregiver Perceptions about Factors Impacting their Ability to Carry out Home-Based Therapy Programmes in Central Botswana: A Qualitative Study

Aim. Home-based programs, as an aspect of Community Based Rehabilitation (CBR), are provided as an integral part of remedial programming for children with disabilities in central Botswana. Observed difficulties with integration of these activities into daily living were deemed worthy of further investigation. The authors’ aim was to gain an in-depth picture of caregiver and therapist perceptions about the factors that impacted ability to carry out prescribed therapy. Methods. Purposive sampling was used. Therapists and caregivers were recruited for semi-structured qualitative interviews through active occupational therapy and physiotherapy contacts in central Botswana. Caregivers lived in different villages served by CBR and had been referred for therapy at the NGO branch office. Twelve questions for caregivers and 9 for therapists were presented during in-person meetings. Results. Interviews with 5 caregiver family members and 4 therapists were audio recorded and transcribed by the first author. Thematic analysis combined manual coding and NVivo software. Participant response themes described both direct and indirect influences on adherence to the home program. Direct influence themes were child characteristics, therapy competence and frequency, competing demands, and other issues. Indirect influence themes, which represented major impediments for carrying out a home program, were insufficient preparedness of healthcare providers, mismatched social welfare services, support system inadequacies, and language barriers. Conclusions. The findings of this study underscore the need for understanding the lived experiences of parents and other caregivers who are charged with carrying out home-based therapy programs for children with disabilities. Given this knowledge, workers in the CBR system can implement solutions in the community designed to educate policymakers and workers in the social welfare system while assisting clients to overcome barriers and advocate for their needs.