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Abstract
Introduction In low-income and middle-income countries, it is estimated that one in every three preschool-age children are failing to meet cognitive or socioemotional developmental milestones. Thailand has implemented a universal national developmental screening programme (DSPM) for young children to enable detection of developmental disorders and early intervention that can improve child health outcomes. DSPM implementation is being hampered by low attendance at follow-up appointments when children fail the initial screening.
Methods Action research, using qualitative methods was conducted with 19 caregivers, 5 health workers and 1 chief at two Health Promotion Hospitals to explore the factors affecting attendance at follow-up appointments. Transcripts and notes were analysed using descriptive content analysis. Findings were then discussed with 48 health workers, managers, researchers and policymakers.
Results The high workload of health workers during busy vaccination clinics, and inadequate materials prevented clear communication with caregivers about the screening, how to stimulate child development and the screening result. Caregivers, particularly grandparents, had a lack of understanding about how to stimulate child development, and did not fully understand failed screening results. Caregivers felt blamed for not stimulating their child’s development, and were either worried that their child was severely disabled, or they did not believe the screening result and therefore questioned its usefulness. This led to a lack of attendance at follow-up appointments.
Conclusion Task-sharing, mobile health (mhealth), community outreach and targeted interventions for grandparent caregivers might increase awareness about child development and screening, and allow health workers more time to communicate effectively. Sharing best practices, communication training and mentoring of DSPM workers coupled with mhealth job aids could also improve caregiver attendance at follow-up. Engagement of caregivers in understanding the barriers to attendance at follow-up and engagement of stakeholders in the design and implementation of interventions is important to ensure their effectiveness.
- developmental disabilities
- preschool children
- caregivers
- child development
- community-institutional relations
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Footnotes
PCG and GLE contributed equally.
Contributors All authors conceived the study during a workshop, and participated in study design, data analysis, participant engagement and write-up. JM wrote the first draft of the manuscript, and IC, PB, PCG and GLE commented, added to and edited the manuscript.
Funding This research was funded by the Naughton/Clift Matthews Global Health Fund. University College London Global Engagement Funds provided additional support for JM’s travel, and the King’s College London Global Research Grant supported travel for PCG and GLE. Initial networking between the authors was facilitated by the Newton Fund in partnership with the British Council and Thailand Research Fund.
Competing interests None declared.
Ethics approval University College London Research Ethics Committee and Thammasat University Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data are available on application to the corresponding author. Participants gave informed consent for data sharing.