Exploring the Accessibility of Community-Based Telerehabilitation for Children with Disabilities from Low-Income Households

Authors

  • Karen S. Sagun Occupational Therapy Department, College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines and Quezon City Kabahagi Center for Children with Disabilities, Quezon City Government, Philippines
  • Ryanne Nicole H. Alava 1 Occupational Therapy Department, College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines
  • Kristine Therese S. Cablay Occupational Therapy Department, College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines
  • Katelyn A. Dagdag Occupational Therapy Department, College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines
  • Francis Rowelle P. Lagman Occupational Therapy Department, College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines
  • Kvaern Edgar S. Nocos Occupational Therapy Department, College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines
  • Jamela Y. Quidilla Occupational Therapy Department, College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines
  • Nina Mari M. Tan Occupational Therapy Department, College of Rehabilitation Sciences, University of Santo Tomas, Manila, Philippines

DOI:

https://doi.org/10.5195/ijt.2024.6625

Keywords:

Children with disabilities, Telerehabilitation, Community-Based Rehabilitation, Urban poor, Philippines

Abstract

Community-Based Rehabilitation (CBR) is a rights-based approach that aims to provide equitable health services and participation opportunities for people with disabilities. Telerehabilitation has emerged as a potential methodology for delivering health care within the CBR framework. However, the accessibility of telerehabilitation presents unique challenges for children with disabilities (CWD) in communities with low socioeconomic status. This phenomenological qualitative study explores the barriers and facilitators that influence the participation of families of CWD in telerehabilitation as a method of CBR in urban poor communities. Nine focus group discussions (FGDs) were conducted involving 75 primary caregivers of CWD. Inductive thematic analysis using NVivo software was employed to analyze the collected data, revealing four themes that impact participation in Telerehabilitation: Economic and Social Resources, Self-Competency Affecting Transition, Flexible Service Delivery Mechanism, and Safety and Security as a Threat to Participation. The findings emphasize the intricate interplay of factors influencing the accessibility of telerehabilitation services for CWD from low-income households. Actionable strategies to address these challenges include providing affordable technology and internet access, offering training and support to families, developing culturally sensitive resources, establishing safety protocols, and advocating for inclusive policies and funding mechanisms. Collaboration among healthcare professionals, policymakers, and families is essential in building a resilient and equitable healthcare system that prioritizes the needs of CWD living in poverty. The insights gained from this study can inform the development of targeted interventions and support systems to ensure that no child is left behind in accessing quality care despite the digital and socioeconomic divides.

  

References

Akamoglu, Y., & Meadan, H. (2018). Parent-implemented language and communication interventions for children with developmental delays and disabilities: A scoping review. Review Journal of Autism and Developmental Disorders, 5(3), 294–309. https://doi.org/10.1007/s40489-018-0140-x

Archibald, M. M., Ambagtsheer, R. C., Casey, M. G., & Lawless, M. (2019). Using Zoom videoconferencing for qualitative data collection: Perceptions and experiences of researchers and participants. International Journal of Qualitative Methods, 18, 160940691987459. https://doi.org/10.1177/1609406919874596

Ashburner, J., Vickerstaff, S., Beetge, J., & Copley, J. (2016). Remote versus face-to-face delivery of early intervention programs for children with autism spectrum disorders: Perceptions of rural families and service providers. Research in Autism Spectrum Disorders, 23, 1–14. https://doi.org/10.1016/j.rasd.2015.11.011

Azungah, T. (2018). Qualitative research: deductive and inductive approaches to data analysis. Qualitative Research Journal,18(4), 383–400. doi: https://doi.org/10.1108/QRJ-D-18-00035

Banks, L. M., Kuper, H., & Polack, S. (2017). Poverty and disability in low- and middle-income countries: A systematic review. PLoS ONE, 12(12), e0189996. https://doi.org/10.1371/journal.pone.0189996

Bate, J., & Malberg, N. (2020). Containing the anxieties of children, arents and families from a distance during the Coronavirus pandemic. Journal of Contemporary Psychotherapy, 50(4), 285–294. https://doi.org/10.1007/s10879-020-09466-4

Bazen, A., Barg, F. & Takeshita, J. (2021). Research techniques made simple: An introduction to qualitative research. Journal of Investigative Dermatology. https://doi.org/10.1016/j.jid.2020.11.029

Boelsma, F., Bektas, G., Wesdorp, C. L., Seidell, J. C., & Dijkstra, S. C. (2021). The perspectives of parents and healthcare professionals towards parental needs and support from healthcare professionals during the first two years of children’s lives. International Journal of Qualitative Studies on Health and Well-Being, 16(1). https://doi.org/10.1080/17482631.2021.1966874

Bongo, P., Dziruni, G., & Muzenda-Mudavanhu, C. (2018). The effectiveness of community-based rehabilitation as a strategy for improving quality of life and disaster resilience for children with disability in rural Zimbabwe. Jamba: Journal of Disaster Risk Studies, 10(1), 442. https://doi.org/10.4102/jamba.v10i1.442

Butchart, J., Harrison, R., Ritchie, J., Martí, F., McCarthy, C., Knight, S., & Scheinberg, A. (2019). Child and parent perceptions of acceptability and therapeutic value of a socially assistive robot used during pediatric rehabilitation. Disability and Rehabilitation, 43(2), 163–170. https://doi.org/10.1080/09638288.2019.1617357

Camden, C., Pratte, G., Fallon, F., Couture, M., Berbari, J., & Tousignant, M. (2019). Diversity of practices in telerehabilitation for children with disabilities and effective intervention characteristics: results from a systematic review. Disability and Rehabilitation, 42(24), 3424–3436. https://doi.org/10.1080/09638288.2019.1595750

Carter, N., Bryant-Lukosius, D., DiCenso, A., Blythe, J., & Neville, A. J. (2014). The use of triangulation in qualitative research. Oncology Nursing Forum, 41(5), 545–547. https://doi.org/10.1188/14.onf.545-547

Chivate, S., Sharma, M., Shaikh, A., & Satarkar, C. (2022). Benefits and challenges of telerehabilitation use by pediatric physiotherapists during the COVID-19 pandemic in Western and Southern India: A cross sectional survey. International Journal of Telerehabilitation, 14(1). https://doi.org/10.5195/ijt.2022.6466

Clarke, V., & Braun, V. (2016). Thematic analysis. The Journal of Positive Psychology, 12(3), 297–298. https://doi.org/10.1080/17439760.2016.1262613

Cohen, J. A., Deblinger, E., & Mannarino, A. P. (2018). Trauma-focused cognitive behavioral therapy for children and families. Psychotherapy Research, 28(1), 47–57. https://doi.org/10.1080/10503307.2016.1208375

Commission on Human Rights. Human Rights Advisory on the Accessibility as a Matter of Right of Persons with Disabilities. https://chr2bucket.storage.googleapis.com/wp-content/uploads/2019/08/08171214/Human-Rights-Advisory-on-the-Accessibility-as-a-Mtter-of-Rights-of-Persons-with-Disabilities-A2019-005.pdf

Cresswell, J. W., & Plano Clark, V. L. (2017). Designing and conducting mixed method research (3rd ed.). Thousand Oaks, CA: Sage Publications. https://bayanbox.ir/view/236051966444369258/9781483344379-Designing-and-Conducting-Mixed-Methods-Research-3e.pdf

Delos Reyes, R. C., Baes, D. M., Gualberto, S. M., Pagcaliwagan, E. (2021). Experiences of university students during COVID-19: A case study using occupational justice perspective. Journal of Social Health. 2021; 4(1):1-9. https://socialhealthjournal.ust.edu.ph/wp-content/uploads/2021/02/Delos-Reyes-et-al-Experiences-of-University-Students-during-COVID-19-A-Case-Study-using-Occupational-Justice-Perspective-.pdf

Dew, A., Bulkeley, K., Veitch, C., Bundy, A., Gallego, G., Lincoln, M., Brentnall, J., & Griffiths, S. (2012). Addressing the barriers to accessing therapy services in rural and remote areas. Disability and Rehabilitation, 35(18), 1564–1570. https://doi.org/10.3109/09638288.2012.720346

Doody, O., Slevin, E., & Taggart, L. (2013). Preparing for and conducting focus groups in nursing research: Part 2. British Journal of Nursing, 22(3), 170–173. https://doi.org/10.12968/bjon.2013.22.3.170

Eguia, K. F., & Capio, C. M. (2022). Teletherapy for children with developmental disorders during the COVID‐19 pandemic in the Philippines: A mixed‐methods evaluation from the perspectives of parents and therapists. Child Care Health and Development, 48(6), 963–969. https://doi.org/10.1111/cch.12965

Ertan, D., El-Hage, W., Thierrée, S., Javelot, H., & Hingray, C. (2020). COVID-19: Urgency for distancing from domestic violence. European Journal of Psychotraumatology, 11(1). https://doi.org/10.1080/20008198.2020.1800245

Fabriz, S., Mendzheritskaya, J., & Stehle, S. (2021). Impact of synchronous and asynchronous settings of online teaching and learning in higher education on students' learning experience during COVID-19. Frontiers in Psychology, 12, 733554. https://doi.org/10.3389/fpsyg.2021.733554

Fisher, K. R., & Purcal, C. (2016). Policies to change attitudes to people with disabilities. Scandinavian Journal of Disability Research, 19(2), 161–174. https://doi.org/10.1080/15017419.2016.1222303

Griffith, A. K. (2020). Parental burnout and child maltreatment during the COVID-19 pandemic. Journal of Family Violence. https://doi.org/10.1007/s10896-020-00172-2

Grillo, E. U. (2017). Results of a survey offering clinical insights into speech-language pathology telepractice methods. International Journal of Telerehabilitation, 9(2), 25–30. https://doi.org/10.5195/ijt.2017.6230

Hao, Y., Zhang, S., Conner, A., & Lee, N. Y. (2021). The evolution of telepractice use during the COVID-19 pandemic: Perspectives of pediatric speech-language pathologists. International Journal of Environmental Research and Public Health, 18(22), 12197. https://doi.org/10.3390/ijerph182212197

Houghton, C., Casey, D., Shaw, D., & Murphy, K. (2013). Rigour in qualitative case-study research. Nurse Researcher, 20(4), 12–17. https://doi.org/10.7748/nr2013.03.20.4.12.e326

Kolehmainen, N., Duncan, E., McKee, L., & Francis, J. (2010). Mothers' perceptions of their children's occupational therapy processes: A qualitative interview study. British Journal of Occupational Therapy, 73(5), 192–199. https://doi.org/10.4276/030802210X12734991664101

Kokorelias, K. M., Gignac, M. A. M., Naglie, G., & Cameron, J. I. (2019). Towards a universal model of family-centered care: A scoping review. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4394-5

Kourti, A., Stavridou, A., Panagouli, E., Psaltopoulou, T., Spiliopoulou, C., Tsolia, M., Sergentanis, T. N., & Tsitsika, A. (2021). Domestic violence during the COVID-19 pandemic: A systematic review. Trauma, Violence, & Abuse. https://doi.org/10.1177/15248380211038690

Kruijsen-Terpstra, A. J., Verschuren, O., Ketelaar, M., Riedijk, L., Gorter, J. W., Jongmans, M. J., Boeije, H., & LEARN 2 MOVE 2-3 Study Group (2016). Parents' experiences and needs regarding physical and occupational therapy for their young children with cerebral palsy. Research in Developmental Disabilities, 53-54, 314–322. https://doi.org/10.1016/j.ridd.2016.02.012

Kruse, C., & Heinemann, K. (2021). Facilitators and barriers to the adoption of telemedicine during the first year of COVID-19: Systematic review. Journal of Medical Internet Research, 24(1), e31752. https://doi.org/10.2196/31752

Kubenz, V., & Kiwan, D. (2022). “Vulnerable” or systematically excluded? The impact of COVID-19 on disabled people in Low- and Middle-Income countries. Social Inclusion, 11(1). https://doi.org/10.17645/si.v11i1.5671

Lam, J. H. Y., Lee, S. M. K., & Tong, X. (2021). Parents' and students' perceptions of telepractice services for speech-language therapy during the COVID-19 pandemic: Survey study. JMIR Pediatrics and Parenting, 4(1). https://doi.org/10.2196/25675

Lambert, G., Alos, N., Bernier, P., Laverdière, C., Drummond, K., Dahan-Oliel, N., Lemay, M., Veilleux, L.-N., & Kairy, D. (2021). Patient and parent experiences with group telerehabilitation for child survivors of acute lymphoblastic leukemia. International Journal of Environmental Research and Public Health, 18(7), 3610. https://doi.org/10.3390/ijerph18073610

Lincoln, M., Hines, M., Fairweather, C., Ramsden, R., & Martinovich, J. (2015). Multiple stakeholder perspectives on teletherapy delivery of speech pathology services in rural schools: A preliminary, qualitative investigation. International Journal of Telerehabilitation, 6(2), 65–74. https://doi.org/10.5195/ijt.2014.6155

Longo, E., de Campos, A. C., & Schiariti, V. (2020). Covid-19 pandemic: Is this a good time for implementation of home programs for children's rehabilitation in low- and middle-income countries? Physical & Occupational Therapy In Pediatrics, 40(4), 361–364. https://doi.org/10.1080/01942638.2020.1759947

Lukersmith, S., Hartley, S., Kuipers, P., Madden, R., Llewellyn, G., & Dune, T. (2013). Community-based rehabilitation (CBR) monitoring and evaluation methods and tools: A literature review. Disability and Rehabilitation, 35(23), 1941–1953. https://doi.org/10.3109/09638288.2013.770078

Macariola, A. D., Santarin, T. M. C., Villaflor, F. J. M., Villaluna, L. M. G., Yonzon, R. S. L., Fermin, J. L., Kee, S. L., AlDahoul, N., Karim, H. A., & Tan, M. J. T. (2021). Breaking barriers amid the pandemic: The status of telehealth in Southeast Asia and its potential as a mode of healthcare delivery in the Philippines. Frontiers in Pharmacology, 12, 754011. https://doi.org/10.3389/fphar.2021.754011

Madsen, L. S., Jakubec, S. L., V. Nielsen, C., & Handberg, C. (2021). The potential of outdoor contexts within community-based rehabilitation to empower people with disabilities in their rehabilitation. Disability and Rehabilitation, 1–12. https://doi.org/10.1080/09638288.2021.1897887

Magnusson, D., Roe, M., & Hartman, J. (2016). Community perspectives: Evaluation of a community-based rehabilitation program in Southern Belize one year post-implementation. Disability and Rehabilitation, 39(21), 2190–2197. https://doi.org/10.1080/09638288.2016.1219399

Maher, C., Hadfield, M., Hutchings, M., & de Eyto, A. (2018). Ensuring rigor in qualitative data analysis: A design research approach to coding combining NVivo with traditional material methods. International Journal of Qualitative Methods, 17(1). https://doi.org/10.1177/1609406918786362

Montemayor M. (2018). QC builds care center for CWDs. Philippine News Agency. https://www.pna.gov.ph/articles/1034520

Motz, S. (2018). Article 11 Situations of Risk and Humanitarian Emergencies. The UN Convention on the Rights of Persons with Disabilities: A Commentary, Oxford Commentaries on International Law. https://doi.org/10.1093/law/9780198810667.003.0012

Murtonen, K.-P. (2018). Strengths and limitations of using mobile technology in community based rehabilitation in a resource-poor setting [MA thesis, University of Tampere]. In CORE Reader. https://core.ac.uk/reader/250156607

Neubauer, B. E., Witkop, C. T., & Varpio, L. (2019). How phenomenology can help us learn from the experiences of others. Perspectives on Medical Education, 8(2), 90–97. https://doi.org/10.1007/s40037-019-0509-2

Nevill, R. E., Lecavalier, L., & Stratis, E. A. (2016). Meta-analysis of parent-mediated interventions for young children with autism spectrum disorder. Autism, 22(2), 84–98. https://doi.org/10.1177/1362361316677838

Nyumba, T., Wilson, K., Derrick, C. J., & Mukherjee, N. (2018). The use of focus group discussion methodology: Insights from two decades of application in conservation. Methods in Ecology and Evolution, 9(1), 20–32. https://doi.org/10.1111/2041-210x.12860

Ownsworth, T., Theodoros, D., Cahill, L., Vaezipour, A., Quinn, R., Kendall, M., Moyle, W., & Lucas, K. (2019). Perceived usability and acceptability of videoconferencing for delivering community-based rehabilitation to individuals with acquired Brain Injury: A qualitative investigation. Journal of the International Neuropsychological Society, 26(1), 47–57. https://doi.org/10.1017/s135561771900078x

Philippine Academy of Occupational Therapists, Inc. (PAOT). (2020). Guidelines on the utilization of telehealth as an alternative form of occupational therapy service provision. World Federation of Occupational Therapists. https://www.wfot.org/assets/resources/PAOT-Guidelines-on-the-Utilization-of-Telehealth.pdf

Philippine Statistics Authority. (2013). Persons with disability in the Philippines (Results from the 2010 Census). https://psa.gov.ph/content/persons-disability-philippines-results-2010-census

Pregel, A., & Le Fanu, G. (2020, May). Including people with disabilities in responses to the COVID-19 pandemic Guidance for development partners May 2020. Sightsavers. https://www.sightsavers.org/wp-content/uploads/2020/05/Including-people-with-disabilities-in-the-COVID-19-response_Guidance-notes.pdf

Raghavan, A., Demircioglu, M. A., & Taeihagh, A. (2021). Public health innovation through cloud adoption: A comparative analysis of drivers and barriers in Japan, South Korea, and Singapore. International Journal of Environmental Research and Public Health, 18(1), 334. https://doi.org/10.3390/ijerph18010334

Robertson, J., Emerson, E., Hatton, C., & Yasamy, M. T. (2012). Efficacy of community-based rehabilitation for children with or at significant risk of intellectual disabilities in low- and middle-income countries: A review. Journal of Applied Research in Intellectual Disabilities, 25(2), 143–154. https://doi.org/10.1111/j.1468-3148.2011.00679.x

Sengupta, K., Javeri, A., Mascarenhas, C., Khaparde, O., & Mahadik, S. (2021). Feasibility and acceptability of a synchronous online parent-mediated early intervention for children with autism in a low resource setting during COVID-19 pandemic. International Journal of Disability, Development and Education, 1–17. https://doi.org/10.1080/1034912X.2021.1937957

Shapiro, (2013). Behavioral kernels and brief interventions: Teaching parents effective behavior management strategies. North Carolina Medical Journal, 74(1), 57–59. https://doi.org/10.18043/ncm.74.1.57

Stalmeijer, R. E., Mcnaughton, N., & Van Mook, W. N. (2014). Using focus groups in medical education research: AMEE Guide No. 91. Medical Teacher, 36(11), 923–939. https://doi.org/10.3109/0142159X.2014.917165

Tambyraja, S. R., Farquharson, K., & Coleman, J. (2021). Speech-language teletherapy services for school-aged children in the United States during the COVID-19 pandemic. Journal of Education for Students Placed at Risk (JESPAR), 26(2), 91–111. https://doi.org/10.1080/10824669.2021.1906249

UNICEF. (2022). Cost of raising children with disabilities in the Philippines. https://www.unicef.org/philippines/media/5941/file/Full%20report%20-%20cost%20of%20raising%20children%20with%20disabilities%20in%20the%20Philippines.pdf

Velasco, J. V., Obnial, J. C., Pastrana, A., Ang, H. K., Viacrusis, P. M., & Lucero-Prisno, D. E., III. (2021). COVID-19 and persons with disabilities in the Philippines: A policy analysis. Health Promotion Perspectives, 11(3), 299–306. https://doi.org/10.34172/hpp.2021.38

Weerathunge, H. R., Segina, R. K., Tracy, L., & Stepp, C. E. (2021). Accuracy of acoustic measures of voice via telepractice videoconferencing platforms. Journal of Speech, Language, and Hearing Research, 64(7), 2586–2599. https://doi.org/10.1044/2021_jslhr-20-00625

World Federation of Occupational Therapists. (2021). World Federation of Occupational Therapists' position statement on telehealth. https://wfot.org/resources/occupational-therapy-and-telehealth

World Health Organization. (2015). WHO global disability action plan 2014–2021: Better health for all people with disability. https://www.who.int/publications/i/item/who-global-disability-action-plan-2014-2021

Yoo, J., Yoon, M. S., Lee, C. K., Hong, G. H., & Choi, S. J. (2020). An exploratory survey of priorities in establishing telepractice system for SLPs and caregivers in Korea. Communication Disorders Quarterly. https://doi.org/10.1177/1525740120916414

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Published

2025-01-15

How to Cite

Sagun, K. S., Alava, R. N. H., Cablay, K. T. S., Dagdag, K. A., Lagman, F. R. P., Nocos, K. E. S., Quidilla, J. Y., & Tan, N. M. M. (2025). Exploring the Accessibility of Community-Based Telerehabilitation for Children with Disabilities from Low-Income Households. International Journal of Telerehabilitation, 16(2). https://doi.org/10.5195/ijt.2024.6625

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Telehealth Consumerism