Perceived benefits of implementing a caregiver-led training programme for caregivers of children with cerebral palsy in rural Mangochi, Malawi: a qualitative exploration

Introduction: caregiver-led training programmes aim to address gaps in rehabilitation services for children with cerebral palsy (CP) in rural Malawi. This qualitative study explored the benefits of implementing such a programme in a rural setting in Malawi. Methods: a qualitative study was conducted in August 2023, involving in-depth interviews with 11 caregivers, four expert caregivers, and two physiotherapists who participated in the Malamulele Onward Carer-2-Carer Training Programme. Data were analyzed thematically using four constructs of the RE-AIM framework: reach, effectiveness, adoption, and maintenance. Results: caregivers reported improved knowledge of CP, enhanced caregiving skills, and positive shifts in attitudes, contributing to better well-being for themselves and their children. The programme fostered family engagement, dispelled myths about CP, and increased community awareness. Notably, caregivers trained by fellow caregivers described a stronger sense of empowerment, increased confidence in their caregiving abilities, and greater willingness to share knowledge within their communities. Physiotherapists observed that caregiver-led facilitation encouraged peer support and collective problem-solving. Additionally, physiotherapists gained confidence in managing CP and experienced reduced workloads as caregivers took on more responsibilities. Potential for maintenance of caregiving practices and community engagement was evident; however, long-term sustainability and scalability will require structured policy-level support. Conclusion: this qualitative study demonstrates caregivers´ and physiotherapists´ perceived improvements in knowledge, skills, attitudes, and well-being, alongside enhanced social inclusion and reduced stigma associated with participation in the caregiver-led training programme. These findings suggest that caregiver-led approaches may hold potential for scalability and sustainability in low-resource settings, offering an accessible strategy for addressing rehabilitation gaps.