DOI: https://doi.org/10.47405/mjssh.v7i4.1419
The Effectiveness of Cerebral Palsy Support Intervention on Perceived Social Support Among Caregivers of Children with Cerebral Palsy in North-Eastern Region, Malaysia
Siti Aisyah Zakaria1 , Azriani Ab Rahman2* , Mohd Ismail Ibrahim3,
Raishan Shafini Bakar4 , Mohd Zulkifli Abdul Rahim5 , Nor Haslina Mohd6 , Nor Azni Yahaya7
1Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Email: [email protected]
2Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Email: [email protected]
3Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Email: [email protected]
4Department of Psychiatry, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Email: [email protected]
5School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Email: [email protected]
6School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Email: [email protected]
7Hospital Raja Perempuan Zainab II, 15586 Kota Bharu, Kelantan, Malaysia.
Email: [email protected]
CORRESPONDING AUTHOR (*):
Azriani Ab Rahman ([email protected]) KEYWORDS:
Cerebral palsy Caregivers Social support Intervention
Multidisciplinary team CITATION:
Siti Aisyah Zakaria et al. (2022). The Effectiveness of Cerebral Palsy Support Intervention on Perceived Social Support Among Caregivers of Children with Cerebral Palsy in North-Eastern Region, Malaysia. Malaysian Journal of Social Sciences and Humanities (MJSSH), 7(4), e001419.
https://doi.org/10.47405/mjssh.v7i4.1419
ABSTRACT
Cerebral palsy (CP) is a lifelong disorder that requires a fulltime commitment from the caregivers. Due to the complexity of care and complications associated with CP, the caregivers of children with CP require a good social support.
This study aimed to determine the impact of CP support intervention on caregivers perceived social support.This quasi-experimental study involved caregivers of children with CP from community-based rehabilitation (CBR) centers. The intervention group (n=21) were given CP Support intervention through provision of information and social support from a multidisciplinary team including governmental, non-governmental organizations (NGO) and parents. It contains information enrichment workshop (IEW), caregivers support group (CSG), and WhatsApp group. The control group (n=45) received only usual care.
Factorial ANCOVA revealed that higher level of perceived social support was observed in the intervention group at the end of the study. The intervention effect was significant after six months post intervention when other variables were controlled (p = 0.031). Findings of this study highlighted the favorable outcome of the CP Support intervention program
on the caregivers’ perceived social support through provision of information and social support.
Contribution/Originality: This study contributes to the existing literature on the importance of social support provided to caregivers of children with cerebral palsy. It documents the effectiveness of social support intervention in improving perceived social support among the caregivers which justifies the need of implementing family centered care in a multidisciplinary approach.
1. Introduction
Raising a child with CP can be a challenging experience for caregivers due to movement disorders and other multiple comorbidities such as feeding difficulties, epilepsy, behavioral problems, osteopenia, osteoporosis, and functional gastrointestinal abnormalities that may affect CP child’s dependency towards others (Krigger, 2006).
Despite CP is non-progressive, the lifelong health care needed in caring for a child with CP poses the family members particularly parents as the most immediate caregivers towards low health-related quality of life (HRQOL), predisposing them to depressed and anxious moods, and stress with higher maternal burden was recorded as compared to caregivers of typically-developing children (Barlow, Cullen‐Powell, & Cheshire, 2006; Guillamón et al., 2013; Lee, Matthews, & Park, 2019; Ozkan, 2018).
In Malaysia, the most common disability was learning disability followed by physical disabilities (UNICEF, 2014). Due to the lack of systematic and reliable data collection and compilation for children with disabilities, there was a discrepancy on the prevalence of cerebral palsy reported by different ministries. As such, whilst the Department of Social Welfare ranked physical disabilities as second highest after learning disabilities, a report from the same department found that there was no new case of a cerebral palsy case registered between 2011 and 2012 (UNICEF, 2014). Whereas the Ministry of Health reported more than twenty percent increment in the detection of newly diagnosed children with CP according to types of (UNICEF, 2014). The difference could be due to CP can be reported as under physical or multiple disabilities categories. This suggests that the figure reported is a gross underestimate as there is no proper national data nor registry on the prevalence of CP children available in Malaysia (Isa et al., 2013). As the registration of disability is on a voluntary basis (UNICEF, 2014), this leads to low registrations, as parents do not register their children due to perceived stigma (Amar, 2008).
This study aimed to determine the impact of CP support intervention on caregivers perceived social support by comparing the perceived social support score of caregivers with CP children at pre-intervention and six months post-intervention.
2. Literature Review
Despite the current support delivered by the governmental and non-governmental agencies in providing different means of benefit towards children with disabilities in Malaysia, the caregivers still expressed their concern about having an intervention that provides more social support especially support from other parents whose children had a similar condition (Sy & Ms, 2011). The same challenges and everyday experiences they face in handling their disabled children could establish the similarity between them, and
they could support each other hand in hand. The caregivers also requested for interventions that provide more information about their child’s growth and development, child’s condition, how to handle the child’s behavior, how to play, talk or teach their child as well as services presently available for their child (Sy & Ms, 2011). This is due to caregivers reported that they have difficulty in obtaining information or have little access to the information they needed because they failed to get help and have no idea where to acquire the information needed (Sy & Ms, 2011).
To our knowledge, there is no local study specifically looking at the effectiveness of CP intervention program which involves a group of multidisciplinary professionals in medical, health field, social support organizations and parents as well as utilizing a social media. Several studies proved the effectiveness of using social media (Shaw et al., 2015) and involving multidisciplinary professionals (Hu et al., 2016) in improving health education and social support to the target groups. Given the need for an intervention study, provision of information and social support to the caregivers of children with CP was deemed to be paramount that may empower them towards better care of CP children and subsequently better quality of life. In light of this, we hoped this study would provide an alternative strategy for improving the care of caregivers of children with CP. This study may also increase stakeholder attention to and awareness of the benefits of implementing family centered care (FCC) in a multidisciplinary approach in an attempt to improve the caregivers perceived social support. It is intended to facilitate more powerful collaborative program that may enhance the capacity building among the caregivers of children with CP themselves and between the caregivers and the professionals.
3. Methodology
A quasi-experimental study was conducted among caregivers whose children were registered with community-based rehabilitation (CBR) centers of Kelantan State Social Welfare Department. Located in the northeast of Peninsular Malaysia, Kelantan state comprises of ten suburb and rural districts. Purposive sampling was used to select the CBR centers according to their respective districts for the ease of logistic and transportation during the intervention program. The inclusion criteria of caregivers were:
(a) care givers of children with a known diagnosis of CP; (b) being 18 years of age or older and (c) being identified as the caregivers who stay with the CP child/children under one- roof and take care of CP child/children. Caregivers with known severe psychiatric disorders were excluded from the study. Twenty-one caregivers were non-randomly assigned in the intervention group and 45 caregivers participated in the control group.
The intervention group was given the CP support intervention program, while the control group received usual care.
Ethical approval was obtained from the Universiti Sains Malaysia (USM) Human Research Ethics Committee (Reference Code: USM/JEPeM/16110487). Additional approval to conduct our study in the Community Based Rehabilitation (CBR) centers in the districts were also granted by the Department of Social Welfare, Putrajaya [Reference Code: JKMM 100/12/5/2: 2017 / 039].
3.1. Instruments
A study pro–forma was used to collect data on the caregivers’ age, gender, marital status, educational level, caregiver-child relationship, employment status, number of children, number of CP children in the family, household income and whether they had extra help
from anyone in caregiving of the CP child. Caregivers were also asked to report on their child's age, gender, age of diagnosis, educational level, and financial assistance received.
Level of stress among caregivers of children with CP was measured using the Malay- translated version Perceived Stress Scale (PSS) – SF Questionnaire which was administered prior to the intervention. The Cronbach‘s alpha coefficient to be acceptable (α = .64) with high total test-retest reliability (r = 0.72) (Mazlan & Ahmad, 2012). It consists of 10 items, each rated on a 5-point Likert scale from 0 (never) to 4 (very often).
Items inquire about degree to which the person has felt stress in various situations over the past month. Question 4, 5, 7 and 8 represent positive items and were reverse scored before summation of all the items score were made. Total score can be ranged from 0 to 40 and higher score indicates higher levels of perceived stress.
The unmet needs of caregivers were assessed using The Family Needs Survey (FNS), developed by Bailey and Simeonsson (1988) and modified versions of it have been widely used to measure family needs in cross sectional studies. Locally, the original version of FNS was translated to Malay language by Sidek et al. (2011) in her study investigating the unmet needs among children with disabilities (CWD) in Selangor. The FNS questionnaire is a 35 item-scale and composed of six subscales; information, social support, community services, explaining to others, financial support and family functioning. For each item, the respondents were asked to choose one of the four response choices: 0= Not applicable, 1=
I definitely do not need help with this, 2= Not sure, 3= I definitely need help with this. The total number of reported unmet needs was obtained by summing the number of item rated 3 by the respondents. Respondents who answered 0, 1 or 2 were given score ‟0”
while respondents who answered 3 in the questionnaire were given score ‟1”. Scores could range from 0 to 35 and higher scores indicated more unmet need. Based on her study, the Malay validated FNS questionnaire was proven to have good internal consistency with overall Cronbach’s alpha of 0.91 and subscales ranging from 0.74 to 0.88 as well as good face and content validity (Sukeri et al., 2017).
Multidimensional Scale of Perceived Social Support (MSPSS-M) is a self-administered measure of social support administered to the intervention and control group before and 6 months after the intervention. It addresses the subjective assessment of social support adequacy. It was designed to assess the perception of social support adequacy from three different sources: Family, Friends and Significant Others. The MSPSS contains 12 items using a 7-point Likert scale ranging from very strongly disagree (1) to agree (7) very strongly. It is simple to use and can be quickly administered and scored (Zimet et al., 1988). Each subscale was calculated for its mean score. For Significant Others subscale, items 1, 2, 5, and 10 were summed across and divided by 4. For Family subscale, items 3, 4,8 and 11 were summed across and divided by 4 and rest of items 6, 7, 9, and 12 were handled in similar way to give the mean score of Friends subscale. Summation across all 12 items then divided by 12 provides a total mean score for MSPSS. Validation study of its Malay translated version demonstrated good reliability with coefficient α for the total MSPSS was 0.89 and the subscales α’s of 0.94, 0.88 and 0.82, respectively for the Significant Others, Friends and Family subscales. The parallel form of reliability and the test– retest reliability after 1 week was also high (Ng et al., 2010).
3.2. CP Support intervention program
The provision of informational support was delivered through an intervention program, known as CP Support program. To the best of our knowledge, there was no such similar
intervention study previously done at CBR centers where multidisciplinary experts from different fields were brought into the community as an outreach program. These distinguished experts were from medical and health, education department as well as from social field. The 6-month CP Support program consisted of three major activities.
The first activity was an introductory workshop on cerebral palsy, also known as information enrichment workshop (IEW). IEW was filled in with three distinctive lectures and hands-on activity by a pediatric neurologist, physiotherapist, and occupational therapist. Each session lasted approximately for 40 minutes to one hour with 15 minutes break in between sessions. The value of having this workshop also acts as an ice-breaking session and promotes rapport between the caregivers and the experts in managing CP children. The second activity was held one month apart from the workshop whereby a forum session was held. The researcher team acted as the moderator and three panels were invited of which one of them was a representative from Department of Social Welfare (DSW), as the official government body in welfare provision, another panel was a representative from Kelantan Foundation For The Disabled as a charitable non- governmental organization and the third panel was from Special Education Unit, Kelantan Education Department to discuss on issues related to the welfare of CP children and their caregivers including training programs and job opportunities as well as special education for CP children. Subsequent from the previous two activities, the engagement of information support through CP Support program was continued with series of caregiver’s support group (CSG) gatherings. To fulfill their unmet needs for information, the caregivers were given opportunity to freely choose their own topics of interest to be discussed in the next CSG gathering. The chosen topics include neurorehabilitation, wheelchair assessment and modification, stress management, importance of oral hygiene, good diet practice for CP children and support for children who require hospital admission. The topics were delivered by neurorehabilitation specialist, wheelchair team coordinator, psychologist, dentist, dietitian, and officer from medical welfare unit respectively. The support from professionals in multidisciplinary teams and other caregivers was continuously provided through a WhatsApp group. The platform is continuously used to update the caregivers on latest program related to CP, for caregivers to express their concern on matters related to their CP children, provide a channel of communication among caregivers themselves, provide a channel for the caregivers to seek expert opinion when in doubt. It reduces gap between caregivers and health experts and sustains the information and social support among caregivers. The intervention package was delivered as a monthly program to the intervention group caregivers in view of logistic problem and to avoid overlapping of program organized by the DSW since our intervention was held at the DSW facility. After completing the post-intervention data collection, caregivers in the control group also received the intervention package for ethical reasons.
3.3. Statistical analysis
Factorial ANCOVA was performed to determine the effect of the intervention. A p-value of less than 0.05 was considered statistically significant.
4. Results
The total number of subjects in the study was 66, of whom 21 were caregivers in the intervention group and 45 were enrolled in a control group. All of them were Malays and majority of them were females (90.9%) where half of them were housewives of which they were categorized under unemployed. The mean age (SD) of the caregivers was 44.23
years old (10.48) and mean (SD) duration of caregiving was 14.33 (8.02) years. Most of the caregivers were married (83.3%). All our respondents were registered with the Department of Social Welfare (DSW), sixty of them received monthly financial support from the DSW. When income was categorized based on B40 cut-off point most of the caregivers had household income of RM 3860 and less (92.4%). Education level,level of perceived stress and FNS score were the variables that had significant difference between intervention and control groups at baseline (p = 0.026, p<0.001 and p<0.001 respectively) (Table 1).
Table 1: Caregivers’ characteristics of control and intervention groups
† Mean (SD) *Independent t-test **Fisher’s exact test ***Chi-square test SD, standard deviation
The mean age (SD) of CP children was 15.27 (7.76) years old. Most of the caregivers (71.2%) indicated that the diagnosis of CP was made when their children were less than one year old. Male CP children were more dominant in number than female CP children.
Fifty-nine of these children actively involved in CBR program or kindergarten, one child was in primary school and two CP children were in secondary school. Most of the caregivers in our study had children with severe CP according to Gross Motor Function Classification System (GMFCS) by Palisano et al. (1997). There was no significant
Variables n (%)
p value Overall
(n = 66) Control
(n = 45) Intervention (n = 21)
Age (years) 44.2(10.84† 44.7(11.45) † 43.3(9.61† 0.633*
Gender Male
Female 6 (9.1)
60 (90.9) 3 (6.7)
42 (93.3) 3 (14.3)
18 (85.7) 0.373**
Education level No formal education/
Primary education
Secondary/Diploma/Degree/
Postgraduate
14 (21.2) 52 (78.8)
13 (28.9) 32 (71.1)
1(4.8)
20 (95.2) 0.026***
Employment status Unemployed Employed
37 (56.1) 29 (43.9)
25 (55.6) 20 (44.4)
12 (57.1) 9(42.9)
0.904***
Income
RM 3860 and less
More than RM 3860 61 (92.4)
5 (7.6) 43 (95.6)
2 (4.4) 18 (85.7)
3 (14.3) 0.386**
Number of children Less than 4
4 and more 28 (42.4)
38 (57.6) 17 (37.8)
28 (62.2) 11 (52.4)
10 (47.6) 0.246***
Training experience Yes
No 14(21.2)
52 (78.8) 8 (17.8)
37 (82.2) 6 (28.6)
15 (71.4) 0.318***
Comorbidities Yes
No
29 (43.9) 37 (56.1)
21(46.7) 24 (53.3)
8 (38.1) 13 (61.9)
0.513***
Duration of caregiving
(years) 14.33 (8.02) 14.80 (8.31) 13.24 (7.30) 0.463*
Level of stress 15.02 (5.98) 13.53 (6.30) 18.19 (3.67) <0.001*
FNS score 19.11 (7.21) 26.95 (7.61) <0.001*
difference in the children’s sociodemographic characteristics between control and intervention groups (Table 2).
Table 2: Cerebral palsy children’s sociodemographic characteristics of control and intervention groups
Variables
n (%)
p value Overall
(n = 66) Control
(n = 45) Intervention (n = 21)
Age of CP child (years) 15.3 (7.76† 16.4(7.86† 13.0(7.18† 0.097* Gender of CP child
Male
Female 42 (63.6)
24 (39.4) 30 (66.7)
15 (33.3) 12 (57.1)
9 (42.9) 0.454**
GMFCS
I, II, III
IV, V 9 (13.6)
57 (86.4) 5 (11.1)
40 (88.9) 4 (19.0)
17 (81.0) 0.382**
Presence of other caretakers
Yes
No 32 (48.5)
34 (51.5) 21 (46.7)
24 (53.3) 11 (52.4) 10 (47.6)
0.665**
† Mean (SD) *Independent t-test **Chi-square test, SD, standard deviation
At baseline, there was no significant difference in pre-MSPSS score (p=0.917) (Table 3).
Table 3: Comparison of baseline (pre-intervention) MSPSS scores between Control and Intervention Groups
Variables Control (n= 45) mean (SD)
Intervention (n = 21) mean (SD)
Mean difference (95% CI)
t- statistics
(df) p value *
Pre-MSPSS 5.02 (0.92) 5.05 (1.14) -0.03 (-0.55, 0.50)
0.10 (64) 0.917
*Independent t-test; SD, standard deviation; CI, confidence interval; df, degree of freedom There was no significant mean score differences observed between pre and post intervention in both groups (Table 4).
Table 4: Comparison of MSPSS scores within groups Variable Groups Pre-
interventio n
Mean (SD)
Post- interventio n
Mean (SD)
Mean difference (95% CI)
t- statistic s (df)
p value*
MSPSS Control 5.02
(0.92) 5.11
(0.68) -0.08
(-0.34, 0.18) -0.63
(44) 0.534 Intervention 4.97
(1.07)
5.28 (0.71)
-0.21 (-0.67, 0.24)
-0.98 (20)
0.338
*Paired t-test CI, confidence interval; df, degree of freedom
Post MSPSS score was higher in the intervention group compared to control group, but the differences between these study groups was not statistically significant (p = 0.392) (Table 5).
Table 5: Comparison of post-MSPSS score between intervention and control groups Mean
(SD) Mean difference
(95% CI) t- statistics
(df) p
value* Group
Control
Intervention 45
21 5.11 (0.71)
5.27 (0.69) -0.16
(-0.53, 0.21) 0.62
(1,64) 0.392
*One-way ANOVA CI, confidence interval; df, degree of freedom
When the possible confounding variables such as pre-MSPSS score, caregivers’ education level, age and level of perceived stress, gender of CP children, number of CP children, duration of caregiving, number of children, income, and severity of CP according to GMFCS were adjusted, the post MSPSS score was significantly different between the two groups (p= 0.031) (Table 6).
Table 6: Comparison of post MSPSS scores between the two study groups after controlling for potential confounders
Adjusted Mean
(95% CI) Adjusted
Mean difference† (95% CI) ‡
F statistics
(df) p
value
Group Control Intervention
45 21
5.03 (4.67, 5.39) 5.45 (5.03, 5.89)
0.42 (0.04, 0.81)
4.88 (1, 54) 0.031
†Adjusted mean using factorial ANCOVA after controlling for pre-MSPSS score, FNS score, caregivers’
education level, caregivers’ age, caregivers’ level of stress, gender of CP children, number of CP children, duration of caregiving, number of children, income, and severity of CP according to GMFCS ‡Bonferroni adjustment for 95%
CI for difference. R squared = 0.566 CI, confidence interval; df, degree of freedom
For each MPSS domain, intervention effect was found to be significant for post-Significant Others (Table 7).
Table 7: Comparison of post MSPSS domain scores (each domain) between the two study groups after controlling for potential confounders
Domain Groups n Adjusted
Mean (95%
CI)
Adjusted Mean difference† (95% CI) ‡
F
statistics (df)
p value
Post Family Control 45 5.43
(4.95, 5.90) 0.38
(-0.16,0.92) 1.98
(1.53) 0.165 Intervention 21 5.80
(5.19, 6.41) Post-Friend Control 45 4.70
(4.20, 5.20) 0.32
(-0.26,0.90) 1.25
(1.53) 0.269 Intervention 21 5.02
(4.36, 5.68) Post
Significant Others
Control 45 5.13
(4.66, 5.59) 0.61
(0.09,1.14) 5.42
(1.53) 0.024 Intervention 21 5.74
(5.14, 6.34)
† Adjusted mean using factorial ANCOVA after controlling for Pre MSPSS score, FNS score, caregivers’
education level, caregivers’ age, caregivers’ level of stress, gender of CP children, number of CP children, duration of caregiving, number of children, income, and severity of CP according to GMFCS ‡Bonferroni adjustment for 95% CI for difference
CI, confidence interval; df, degree of freedom
5. Discussions
Our study shows the baseline MSPSS score was not significant, suggestive of comparable groups of caregivers of children with CP. Despite both groups showed an increment of MSPSS score within the study period, greater improvement is seen in MSPSS score among the intervention group caregivers suggestive of our intervention had merits on improving social support. This finding was further strengthened when the potential confounders were controlled. One possible explanation for the significant intervention effect could be attributed by the characteristics of caregivers in the intervention group who were more stressful compared to the control group. The intervention might be seen as a resolution to overcome their problems as they appreciate this programme much better in the time they need most. As other study suggests that a measure of support received when needed would predict greater perceived support (Melrose, Brown, & Wood, 2015).
Result from the present study found that in general, both groups showed an improvement in social support from family, friends and significant others except for the control group who perceived less support from the significant others. Further examination on each domain of MSPSS revealed that, significant others might contribute to the overall MSPSS intervention effect as shown by the significant intervention effect only on this domain.
Although this present study did not explore further on who were the significant others meant to the caregivers, previous local study done among mothers of children with CP mentioned that the value of spouse as the significant others was essential in providing the most of social support (En & Juhari, 2017). In view of majority of participants in our study were married women, it is possible that they associated spousal support as the source of social support from significant others. Very commonly that caregivers of chronic illness seek help from family members. Since both groups had an increased score in social support from family, we can postulate that spouses are a likely source of social support, in view of most of our caregivers were married mothers. Given the nature of many stressors that they are more likely to be experiencing together, spousal support is crucial in alleviating the burden of caregiving and improving the health outcomes in the main caregivers (Dehle, Larsen, & Landers, 2001). Previous study had demonstrated that support provided by a spouse may take precedence over other sources of support (Siklos
& Kerns, 2006) especially in times of crises when the spouse is often the first person sought for support (Dehle et al., 2001). Though spousal support seems to be superior to other types of support, it is also possible that the caregivers in our study also receive support from other family members. Having said that, on average, the caregivers in our study had five household members living together with a possibility as an extended family. Extended family refers as any persistent kinship grouping of persons related by descent, marriage or adoption, which is wider than the nuclear family, comprising at least three generations, from grandparents (one or both) to grandchildren (Embong, 2002) which is still common in Kelantan. In the absence of spousal support as in a frail marital relationship, the mother, as the child’s major caregiver, tend to seek support in her closest relational system, especially her other children and other women in the family, such as grandmothers and aunts (Lee & Gardner, 2010).
The significant intervention effect may also be explained by the social support provided by other caregivers throughout the discussion either physically or via the WhatsApp group. Social support is more effective when it comes from those who are socially similar in values and characteristics, and who are facing or have faced similar stressors somewhat more successfully (Heaney & Israel, 2008).
Through provision of informational support from the CP Support intervention, blended with the involvement of multidisciplinary team, the caregivers built sense of belonging within the group and increased the size of social network (Boyd, 2002). Evidence from previous interventional study in providing informational supports had shown that participation in professional led group among other parents with children of similar condition increased perception of peer and professional support, boosted their confidence in understanding their child’s condition and increased their capacity in decision making (McAleese, Lavery, & Dyer, 2014; Tolmie, Bruck, & Kerslake, 2017). The presence of WhatsApp group ensures the sustainability of the informational support by the professionals. Caregivers may utilize the WhatsApp group to clarify any doubts regarding problems faced by their CP children which may narrow the gap between professionals and parents. The WhatsApp group is also a platform for the professionals to share any announcement or relevant information to the caregivers.
Nevertheless, the findings should be interpreted with caution due to several limitations.
Randomization was not possible in this study in view of limited sample that was available and logistic problems. Subsequent to having heterogenous groups, presence of extraneous variables is possible that potentially confound the effect of study variables.
Characteristics of the intervention group differed somewhat to those caregivers in the control group most notably in terms of education level and perceived stress. However, the effect of these confounders was controlled in the multivariable analysis.
6. Conclusion
Findings of this study highlighted the favorable outcome of the CP Support intervention program on the caregivers’ perceived social support through provision of information and social support. It justifies the need of implementing family centered care (FCC) in a multidisciplinary approach to improve the caregivers’ perceived social support, thus improving the quality of care to the CP children.
Acknowledgement
We would like to express our gratitude to all participants, USM Cerebral Palsy Research Cluster (CPRC) secretariats, CPRC teams and USM for providing fund via RU Top Down 1001.CSKK.870020 grant and those who directly or indirectly involved in the study.
Funding
USM RU Top Down 1001.CSKK.870020 grant.
Conflict of Interests
The authors declare no conflict of interest in this study.
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