Living Conditions of Children with Disabilities in Rural Thailand: Factors Leading to Life Change through Interventions
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThe current paper, Living Conditions of Children with Disabilities in Rural Thailand: Factors Leading to Life Change through Interventions, presents a snapshot of the daily lives of three children with physical disabilities living in rural Thailand. The authors began by describing wheelchair use, participation and independence levels in activities of daily living, and general living conditions for each participant, and they compared ratings in each area from December 2023 to those reported in March 2023. The authors then discuss these ratings in the context of additional descriptive information and with note to available resources or interventions. The authors conclude by noting that relatively few changes in independence were noted across observations. The relatively short period of time between observations may have impacted the amount of change potential. Another conclusion was that cultural factors may be more influential than access to resources in determining rates of behavior change.
I commend the authors for taking such care in their examination of environmental factors influencing the lives of children with physical disabilities in rural Thailand. This sort of descriptive information is highly valuable in determining priorities for social programs as well as for assessing the utility of existing programs. The authors presented a thorough account of factors related to these children’s independence in a respectful tone without judgement. The specific descriptions they provided will be important for policy-makers and other influential persons to consider as new programs are developed. It is particularly difficult and important to highlight the experiences of those with disabilities and those living in poverty and/or rural conditions, as these authors have done.
Some of the ways in which this information is presented could be revised for clarity.
1) The results begin by describing changes without contextualizing those changes. It would be more clear to begin the results section with a statement such as, “When comparing results observed in March 2023 with those observed in December 2023, the following differences were noted” or something similar to clarify, for example, the statement made in Line 140-141.
2) The results and discussion sections seemed to overlap. A better organization may be to have all new information shared in the results section. Perhaps a subheading of “Lifestyle Goals” or “Additional Comments” or “Supporting Information” could hold this information. When new information is presented in the discussion (e.g., the description of Participant A’s specific toileting status or how she reports her social life), it tends to make the discussion seem less focused and more meandering.
3) The title of section 4.1 is confusing: Target Life and Challenges for Children with Disabilities in Rural Areas. Should this read, “Target Life Goals and Challenges…” or “Targeted Challenges…”?
4) Section 4.1 seems to include both goals and recommendations for addressing these goals. Should there be two sections here? Perhaps named goals can be listed under Results and the Discussion can include recommendations for addressing the goals? Because the recommendations are comprehensive, the authors should consider whether they want to make identifying recommendations part of the purpose of their study. Further, consider adding references to bolster these recommendations so that they appear to be more research-informed/ scholarly and less driven by opinion.
5) I’m not certain that the availability of a resource such as access to school should be described as an intervention. An intervention implies that a specific action was undergone to resolve a named issue. I don’t see that framing in the article. Perhaps the intervention should be more clearly described in terms of issue + related action or perhaps it should be described as a resource. The latter suggestion makes sense in terms of the authors conclusion that access to a resource doesn’t result in resolution of a problem; rather, additional resources and training are needed (Line 389; Line 454).
Other ideas for consideration:
1) Ground the ethical considerations in relation to a published ethical code or set of guidelines. Without any context for what is/is not ethical in this method of research, field of study, or area of the world, it is difficult to assess the comprehensiveness of the ethical considerations described here.
2) Some of the conclusions seem to be in conflict. For example, the suggestion that changes occur only when individuals have “the will” to change appears to put the onus for change on the individual. However, the greater theme seems to be that cultural factors limit change. Perhaps the overall conclusion is that cultural factors affect self-awareness, self-advocacy, and self-actualization. Without these cultural emphases on individual efficacy, individuals are less likely to be aware that they have the ability to implement changes in their lives. This discussion needs more framing and clarity in order to be impactful.
3) It will be important to describe some limitations of the present study. For example, although the in-depth description of each participant is a strength of this article, the small sample size limits the generality of the findings and conclusions. The brief interval between observations should be noted. These and other limitations should be noted in the conclusion, along with recommendations for how future research may address these limitations.
Comments on the Quality of English LanguageSome longer sentences should be separated into two or more sentences because they tended to meander or include too many ideas. This article was coherent and understandable but minor edits and additional punctuation would improve clarity.
Author Response
Please see the attachment.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for AuthorsWell done for your research! It is a very interesting chapter. I have noticed some issues that need to be fixed.
line 32, World Food Programme 2023: needs a comma World Food Programme, 2023
line 33, please replace the word "persons" with the word "individuals"
i can not find where Table 1 is reffered into the main boby of the article. i can find only Table 2
Table 2 needs to be seperated. One table needs to include the demographics of the participants and needs to be placed higher into the main body of the article, closer to participants. The other table needs to be renamed as Table 3 and needs to include all the other information
i need to know if consent from particiapnts' parents was given
chapters: 4.1 and 4.2, need to be connected with the literature and other similar surveys
there is no connection between the discussion and other similar surveys
i need to read about the limitations of this survey
the references need an update, to more recent
Comments on the Quality of English Language
it can be improved. I have highligheted a couple of lines in the text
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for AuthorsPlease see attached.
Comments for author File: Comments.pdf
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Round 2
Reviewer 3 Report
Comments and Suggestions for AuthorsThank you for your responses to my questions. Ideally, I would like to see more literature backing your assumptions however it is a good approach that you have taken pointing to the limitations of the research and making recommendations for future research.
This is such an important topic, not just for Thailand - but for all developing nations where the lives of people living with disability are unnecessarily diminished due to attitudes and environment. Good luck with your advocacy in shining a light on what needs to be done to improve the lives of people living with a disability in Thailand.
