Parental Stress in Raising a Child with Developmental Disabilities in a Rural Community in South Africa
Abstract
:1. Introduction and Background
2. Study Methodology
2.1. Study Design
2.2. Study Setting
2.3. Population of the Study
2.4. Sample Size
2.5. Recruitment
2.6. Inclusion and Exclusion Criteria
2.7. Data Method and Tools
2.8. The Parental Stress Index—Short Form (PSI-SF)
2.9. Adherence to COVID-19 Guidelines
2.10. Data Analysis
2.11. Ethical Considerations
3. Results
3.1. Socio-Demographic of the Mothers and Caregivers
3.2. Sociodemographic Characteristics of the Children
3.3. Prevalence of Parental Stress
3.4. Parental Stress Levels and Sociodemographic Characteristics of Mother and Caregiver
3.5. Factors Associated with Parental Stress
3.5.1. Subscale Levels
3.5.2. Total Parental Stress Levels
3.6. Multivariate Logistic Regression
3.6.1. Multivariate Logistic Regression: Subscale
3.6.2. Discussion
3.7. Strengths and Limitations
3.8. Recommendations
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Mother and Caregiver Characteristics | n (335) | ||
n | % | ||
Age of Mother & caregiver: mean (33.9), SD (7.8) | ≤35 years | 200 | 59.7% |
≥36 year | 135 | 40.3% | |
Marital status | Married | 47 | 14% |
Single | 288 | 86% | |
Place of resident | Urban | 36 | 10.8% |
Rural | 299 | 89.2% | |
Level of education | Did not complete matric | 108 | 32.2% |
Completed matric | 166 | 49.6% | |
Completed tertiary | 61 | 18.2% | |
Employment status | Yes | 50 | 14.9% |
No | 285 | 85.1% | |
Estimated family monthly income | ≥R5001 | 40 | 11.9% |
R2001-R5000 | 10 | 3% | |
Care dependency grant | 285 | 85.1% | |
Income source | Employment | 50 | 14.9% |
Care Dependency Grant | 285 | 85.1% | |
Supported by father of the child | Yes | 304 | 90.8% |
No | 31 | 9.2% | |
Child Related Characteristics | |||
Age of child | ≤4 years | 141 | 42.1% |
5–8 years | 120 | 35.8% | |
≥9 years | 74 | 22.1% | |
Gender | Girls | 104 | 30.9% |
Boys | 231 | 69.1% | |
From the local district (KCD) | Yes | 236 | 70.6% |
No | 99 | 29.4% | |
Place of birth | Hospital | 285 | 85.2% |
Clinic | 38 | 11.3% | |
Home | 12 | 3.5% | |
History of hospitalisation | Yes | 198 | 59.4% |
No | 137 | 40.6% | |
Multiple diagnoses | Yes | 200 | 60.8% |
No | 130 | 39.2% | |
Developmental disability | Cerebral palsy | 63 | 18.7% |
Autism | 31 | 9.6% | |
Communication | 106 | 31.8% | |
Delayed developmentalmilestones | 138 | 41.4% | |
Epilepsy | 78 | 23.2% | |
Other diagnoses | 108 | 32.4% | |
Main health needs | Rehabilitation | 208 | 62.2% |
Multiple Needs | 215 | 64.6% | |
Age of initial intervention | ≤2 years | 247 | 73.3% |
≥3 years | 88 | 26.7% | |
Frequency of hospital visits | Monthly | 245 | 73% |
Once (2/6 months) | 90 | 27% | |
Tertiary level hospital visits | Yes | 196 | 58.8% |
No | 139 | 41.2% | |
Attending school | Yes | 118 | 35.3% |
No | 217 | 64.7% |
Mean (SD) | Normal (≤84%ile) | High (85–89%ile) | Clinically Significant (≥90%ile) | |
---|---|---|---|---|
Parental Distress | 40.7 (10.3) | 136 (40.6%) | 18 (5.4%) | 181 (54%) |
Parent-Child Dysfunctional Interaction | 37.4 (9.5) | 125 (37.3%) | 48 (14.3%) | 162 (48.4%) |
Difficult Child | 37.9 (8.4) | 114 (34%) | 35 (10.5%) | 186 (55.5%) |
n(335) | |||
Frequency n (%) | Normal ≤84%ile (n 139) | High-Clinically Significant ≥85%ile (n 196) | |
Mother and caregiver characteristics | |||
Age of Mother | |||
≤35 y | 200 (59.7%) | 93 (46.5%) | 107 (53.5%) |
≥36 y | 135 (40.3%) | 46 (34.1%) | 89 (65.9%) |
Marital status | |||
Married | 47 (14%) | 19 (40.4%) | 28 (59.6%) |
Single | 288 (86%) | 120 (41.7%) | 168 (58.3%) |
Religion | |||
Christian | 239 (71.3%) | 101 (42.3%) | 138 (57.7%) |
Non-Christian | 96 (28.7%) | 38 (39.6%) | 58 (60.4%) |
Place of resident | |||
Urban | 36 (10.8%) | 19 (52.8%) | 17 (47.2%) |
Rural | 299 (89.3%) | 120 (40.1%) | 179 (59.9%) |
Level of education | |||
Matric & Tertiary | 227 (67.8%) | 96 (42.3%) | 131 (57.7%) |
No matric | 108 (32.2%) | 43 (39.8%) | 65 (60.2%) |
Employment | |||
Yes | 50 (15.7%) | 19 (38%) | 31 (62%) |
No | 285 (84.3%) | 120 (42.1%) | 165 (57.9%) |
Estimated income | |||
≥R5001 | 40 (11.9%) | 14 (35%) | 26 (65%) |
R2001-R5000 | 10 (3%) | 4 (40%) | 6 (60%) |
CDG | 285 (85.1%) | 111 (43.2%) | 146 (56.8%) |
Income source | |||
Salary | 50 (15.5%) | 18 (36.3%) | 32 (60%) |
Care dependency grant | 285 (85.1%) | 121 (42.5%) | 164 (57.5%) |
Availability of financial support | |||
Yes | 304 (94.4%) | 131 (43.1%) | 173 (56.9%) |
No | 31 (5.6%) | 8 (25.8%) | 23 (74.2%) |
Child related characteristics | |||
Age of child | |||
1–4 years | 141 (42.1%) | 58 (41.1%) | 83 (58.9%) |
5–8 years | 120 (35.8%) | 47 (39.2%) | 73 (60.8%) |
≥9 years | 74 (22%) | 34 (46%) | 40 (54%) |
Gender | |||
Girls | 104 (30.9%) | 53 (51%) | 51 (49%) |
Boys | 231 (69.1%) | 86 (37.2%) | 145 (62.8%) |
Local (KCD) | |||
Yes | 236 (70.6%) | 100 (42.4%) | 136 (57.6%) |
No | 99 (29.4%) | 39 (39.4%) | 69 (60.6%) |
Place of birth | |||
Hospital | 285 (85.2%) | 118 (41.4%) | 167 (58.6%) |
Clinic | 38 (11.3%) | 19 (50%) | 19 (50%) |
Home | 12 (3.5%) | 2 (16.7%) | 10 (83.3%) |
History of hospitalisation | |||
Yes | 198 (59.4%) | 91 (46%) | 107 (54%) |
No | 137 (40.6%) | 48 (35%) | 89 (65%) |
Multiple diagnosis | |||
Yes | 200 (60.8%) | 68 (34%) | 132 (66%) |
No | 130 (39.2%) | 70 (53.8%) | 60 (46.2%) |
Single diagnosis | |||
Cerebral Palsy | 63 (18.7%) | 30 (47.6%) | 33 (52.4%) |
Autism | 31 (9.6%) | 14 (45.2%) | 17 (54.8%) |
Communication | 106 (31.8%) | 30 (28.3%) | 76 (71.7%) |
Developmental delay | 138 (41.4%) | 45 (32.6%) | 93 (67.4%) |
Epilepsy | 78 (23.2%) | 35 (44.9%) | 43 (55.1%) |
Other diagnoses | 108 (32.4%) | 47 (43.5%) | 61 (56.5%) |
Health needs | |||
Rehabilitation | 208 (62.2%) | 86 (41.4%) | 122 (58.6%) |
Multiple Needs | 215 (64.6%) | 100 (46.5%) | 115 (53.5%) |
Age of initial Intervention | |||
≤2 years | 247 (73.3%) | 98 (39.7%) | 149 (60.3%) |
≥3 years | 88 (26.7%) | 41 (46.6%) | 47 (53.4%) |
Frequency of hospital visit | |||
Monthly | 245 (73%) | 86 (36.3%) | 156 (63.7%) |
Once in 2/6 months | 90 (27%) | 50 (55.6%) | 40 (44.4%) |
Tertiary level hospital visit | |||
Yes | 196 (58.8%) | 85 (43.4%) | 111 (56.6%) |
No | 139 (41.2%) | 54 (38.8%) | 85 (61.2%) |
Attending school | |||
Yes | 108 (32.2%) | 55 (49.1%) | 55 (50.9%) |
No | 227 (67.8%) | 86 (37.9%) | 141 (62.1%) |
p-Value PSI-SF Subscales | Odds Ratio | 95% CI | ||||
PD | DC | P-CDI | PSI-Total | |||
Mother and caregiver factors | ||||||
Age of Mother | * 0.00 | 0.1 | 0.3 | * 0.02 | 1.8 | 1.09; 2.87 |
Place of resident | 0.1 | * 0.05 | 0.07 | 0.1 | 1.7 | 0.84; 3.45 |
Level of education | 0.9 | * 0.04 | 0.08 | 0.6 | 1.1 | 0.69; 1.89 |
Child related factors | ||||||
Gender of child | 0.16 | * 0.03 | 0.2 | * 0.01 | * 1.8 | 1.09; 2.79 |
History of hospitalisation | 0.5 | * 0.02 | * 0.02 | * 0.04 | 0.6 | 0.40; 0.99 |
Multiple diagnoses | 0.1 | * 0.00 | * 0.01 | * 0.00 | * 2.3 | 1.44; 3.55 |
Communication difficulty | 0.3 | * 0.00 | * 0.01 | * 0.00 | * 2.3 | 1.40; 3.77 |
Developmental delay | 0.1 | 0.1 | * 0.01 | * 0.00 | * 1.9 | 1.19; 2.93 |
Other disorders | 0.4 | * 0.03 | * 0.05 | 0.5 | 0.9 | 0.55; 1.39 |
Multiple health needs | * 0.00 | 0.3 | 0.1 | * 0.00 | 0.6 | 0.35; 0.89 |
Age of intervention | 0.2 | 0.4 | * 0.03 | 0.2 | 0.8 | 0.46; 1.23 |
Freq of a hospital visit | 0.2 | * 0.03 | * 0.00 | * 0.00 | * 2.2 | 1.34; 3.58 |
Special hospital visit | 0.09 | 0.07 | 0.2 | * 0.00 | 0.8 | 0.53; 1.29 |
Attend school | * 0.03 | 0.3 | * 0.00 | * 0.04 | * 1.2 | 0.98; 2.42 |
Odds Ratio | Std. Err. | z | p > z | [95% CI] | |
---|---|---|---|---|---|
Parent Distress(PD) | |||||
Age of Mom | 2.510198 | 0.6661333 | 3.47 | 0.001 | 1.49219; 4.222718 |
School | 2.183299 | 0.5720926 | 2.98 | 0.003 | 1.306387; 3.648839 |
Difficult Child (DC) | |||||
Multiple diagnosis | 2.10799 | 0.5960893 | 2.64 | 0.008 | 1.211069; 3.669172 |
Communication | 1.915711 | 0.6114521 | 2.04 | 0.042 | 1.024815; 3.581084 |
Freq hospital | 1.788001 | 0.5194032 | 2.00 | 0.045 | 1.01181; 3.159632 |
Parental-Child Dysfunctional Interaction(P-CDI) | |||||
Freq hospital | 1.907087 | 0.5182993 | 2.38 | 0.018 | 1.119528; 3.248674 |
School | 2.370937 | 0.659081 | 3.11 | 0.002 | 1.374992; 4.088273 |
Total Parental Stress Scores | |||||
Age of Mother | 2.308863 | 0.6352595 | 3.04 | 0.002 | 1.346477; 3.959108 |
Multiple diagnoses | 2.01489 | 0.5679133 | 2.49 | 0.013 | 1.159667; 3.500818 |
School | 1.978596 | 0.5639807 | 2.39 | 0.017 | 1.131697; 3.45927 |
Freq Hosp | 1.93539 | 0.5690567 | 2.25 | 0.025 | 1.087658; 3.443853 |
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Mbatha, N.L.; Mokwena, K.E. Parental Stress in Raising a Child with Developmental Disabilities in a Rural Community in South Africa. Int. J. Environ. Res. Public Health 2023, 20, 3969. https://doi.org/10.3390/ijerph20053969
Mbatha NL, Mokwena KE. Parental Stress in Raising a Child with Developmental Disabilities in a Rural Community in South Africa. International Journal of Environmental Research and Public Health. 2023; 20(5):3969. https://doi.org/10.3390/ijerph20053969
Chicago/Turabian StyleMbatha, Nontokozo Lilian, and Kebogile Elizabeth Mokwena. 2023. "Parental Stress in Raising a Child with Developmental Disabilities in a Rural Community in South Africa" International Journal of Environmental Research and Public Health 20, no. 5: 3969. https://doi.org/10.3390/ijerph20053969