Non-specialist delivery of the WHO Caregiver Skills Training Programme for children with developmental disabilities: stakeholder perspectives about acceptability and feasibility in rural Ethiopia

Autism and other developmental disabilities (DD) are common in low- and middle-income countries. The World Health Organization (WHO) developed the Caregiver Skills Training (CST) programme to address the needs of families with children with DD globally. This study explored the acceptability and feasibility of the CST facilitated by non-specialists in rural Ethiopia, where contextual factors such as poverty, stigma and low literacy may affect CST delivery. In-depth interviews were conducted with caregivers (n=19) and four focus groups with non-specialist facilitators (n=8) in two rural pilot tests of the CST programme. Results suggested that participants experienced the CST programme as acceptable and relevant for their context but suggested some modifications to improve the programme. Caregivers’ accounts showed that facilitation by non-specialists was acceptable; facilitators emphasised the importance of supervision throughout the programme. Participants indicated that the home visit and group training modalities were acceptable and feasible. Facilitators indicated that some CST topics were difficult to explain to caregivers; the concept of formalised play between caregiver and child was particularly foreign to caregivers. Lack of available toys made it difficult to practise some of the CST exercises. These findings may have relevance to non-specialist delivery of the CST and other parent-mediated interventions in low-resource contexts.