ASSESSMENT ON COPING SKILLS USED BY PARENTS WITH
CHILDREN AFFECTED BY CEREBRAL PALSY ATTENDING
OCCUPATION THERAPY CLINIC AT MARAGUA LEVEL 4
HOSPITAL .
PRESENTED BY:
KIBARA ALEX MUGWERU
DNS/S-0863/IC/22
A PROJECT SUBMITTED TO THE DEPARTMENT OF NURSING
FOR THE FULFILLMENT OF THE AWARD OF DIPLOMA OF
COMMUNITY HEALTH NURSING.
IMPERIAL COLLEGE OF MEDICAL AND HEALTH
SCIENCES
THIKA CAMPUS
P.O BOX 770-01030
THIKA.
DECLARATION
A research project by Kibara Alex Mugweru submitted to the faculty of nursing Imperial College Of
Medical And health Sciences in partial fulfilment of requirement for the award of diploma in Kenya
Registered Community Health Nursing.
I declare that this dissertation is my original work and has never been presented by any award in any
college or university.
AUTHOR Kibara Alex Mugweru
SIGNATURE ………………………………………
SUPERVISOR Madam Faith Korir
SIGNATURE ………………………………………….
DEDICATION
This research is dedicated to my beloved family in particular my parents, brothers, sisters and
cousins for their understanding and moral support during the entire study.
MAY THE ALMIGTY GOD SEND BLESSINGS UPON US
.
ACKNOWLEDGEMENT
I, the researcher would like to extend my heartfelt gratitude to everyone who assisted me during my
period of study.
The Nursing Officer of Maragua sub county hospital who allowed me to carry out the research study
in the occupational therapy clinic.
My research supervisor Madam Faith Korir who guided me all through the research project.
The respondent in Maragua sub county hospital occupational therapy clinic who provided me with
ample information that I required.
To my colleague students of September 2022 class who assisted me in one way or another with
moral support and encouragement.
Special gratitude is extended to Mr. Githinji (occupational therapist Maragua sub county hospital)
who also guided me through the research project.
Last but not least to my family members who greatly encouraged me during the project and same
supported me financially during my entire study period.
May GOD bless you all.
.
TABLE OF CONTENTS PAGE
DECLARATION ………………………………………………………………………………………………………………………. I
DEDICATION ………………………………………………………………………………………………………………………. II
ACKNOWLEDGEMENT ………………………………………………………………………………………………………. III
TABLE OF CONTENTS ………………………………………………………………………………………………………… IV
LIST OF TABLES …………………………………………………………………………………………………………………. V
LIST OF FIGURES ………………………………………………………………………………………………………………. VI
ABBREVIATION ………………………………………………………………………………………………………………. VII
ABSTRACT ……………………………………………………………………………………………………………………. VIII
CHAPTER ONE ……………………………………………………………………………………………………………………1
1.1 Research TOPIC ……………………………………………………………………………………………………………1
1.2 Broad objective……………………………………………………………………………………………………………. 1
1.3 Research Question………………………………………………………………………………………………………. 1
1.5 Background Information……………………………………………………………………………………………… 2
1.6 Study justification…………………………………………………………………………………………………………3
1.7 Problem Statement……………………………………………………………………………………………………… 3
CHAPTER TWO……………………………………………………………………………………………………………………4
Literature Review……………………………………………………………………………………………………………… 4
2.1 Introduction………………………………………………………………………………………………………………… 4
2.2 Coping skills used by parents with children affected with CP……………………………………… 6
2.3 Parents attitude towards children affected with CP…………………………………………………… 7
2.4 Knowledge of parents towards children affected with CP…………………………………………...8
2.5 Common causes of CP………………………………………………………………………………………………. 10
CHAPTER THREE………………………………………………………………………………………………………………10
Research methodology …………………………………………………………………………………………………… 11
Introduction ……………………………………………………………………………………………………………………. 10
3.1 Geography of study area……………………………………………………………………………………………. 10
3.2 Ethnic distribution ……………………………………………………………………………………………………… 10
3.3 Climate ………………………………………………………………………………………………………………………. 11
3.4 Study population ………………………………………………………………………………………………………… 11
3.5 study variables ……………………………………………………………………………………………………………. 11
3.6 Study design………………………………………………………………………………………………………….12
3.7 Sample size determination…………………………………………………………………………………….12
3.8 Data collection instrument…………………………………………………………………………………… 12
3.9 Data collection procedure………………………………………………………………………………………13
3.10 Data analysis technique………………………………………………………………………………………. 13
3.11 Ethical considerations…………………………………………………………………………………………. 14
Implications of the study to nursing practice………………………………………………………………. 15
4.1: Introduction ...............................................................................16
4.2 : Denographic profile of participants.............................................................17
4.3 : Psychological Distress among care givers .................................................................18
4.4 : Coping Mechanisms Employed ...............................................19
4.5 : Challenges in assessing support Services.................................................20
4.6 : Discussion ..................................................21
4:7 : Conclusion............................................................22
5.0 : CONCLUSIONS, DISCUSSIONS, SUMMARY AND
RECOMMENDATION. .................................................................23
5.1 : Summary of Findings.......................................................................24
5.2 : Conclusions..............................................................................25
5.3 : Recommendations .............................................................................26
REFERENCES………………………………………………………………………………………………………………….27
APPENDICES………………………………………………………………………………………………………………….. 28
Appendix 1; Consent form…………………………………………………………………………………………….29
Appendix 2; Administered questionnaires………………………………………………………………………30
Appendix 3; Budget………………………………………………………………………………………………………31
Appendix;4 Work plan………………………………………………………………………………………………….32
ABBREVIATION
OT – Occupational Therapy
CP – Cerebral Palsy
K.R.C.H.N – Kenya Registered Community Health Nurse
FCS – Family Centred Services
lCMHS - Imperial College Of Medical and Health Sciences.
LIST OF TABLES
Age of parents
Age of child affected with cerebral palsy attending occupational therapy clinic
Personal belief contributing towards their children’s condition
Source of information
LIST OF FIGURES
Sex of parents interviewed
Sex of a child suffering from CP attending OT clinic
Whether parents attending OT clinic knew about their children diagnosis
Whether parents have accepted their children
Parent’s education on CP
Utilization of formal community resources as a parent caring for a child with CP
Parental attitude towards their affected children
ABSTRACT
Cerebral palsy is a static neurological condition resulting from brain injury and it’s the commonest
cause of delayed milestones. The main objective of the study was to assess coping skills used by
parents of children affected with CP attending occupational therapy clinic in Maragua sub county
hospital. This was a cross-sectional descriptive study adopting both qualitative and quantitative
approaches to data collection, analysis and presentation. Subjects were selected by systematic
sampling for the study, The tools used to collect data were researcher administered questionnaires.
Results showed that 55% parents knew about their child condition but the sources of information
were from parents who had similar problems and not from health workers, 85% of parents had
negative attitude towards their children. 80% of the parents said that witchcraft was the major
contributing factor to CP and that most parents used the following coping strategies; focusing on
problem solving in general, accepting their children as they are developing tolerance for their child
disabilities, sharing experiences with parents who have similar problems and discussing what they
feel about their children’s condition, isolating the child, locking up the child alone in a room.
Conclusion
The study recommends that the health team should create awareness through health education to
the community on matters pertaining cerebral palsy so that they can change their attitude towards
the affected.
CHAPTER ONE
1.1 RESEARCH TOPIC
Assessment on coping skills used by parents with children affected by cerebral palsy attending
occupational therapy clinic at Maragua sub county hospital
1.2 BROAD OBJECTIVE
To assess coping skills used by parents of children affected by cerebral palsy attending occupation
therapy clinic
1.3 SPECIFIC OBJECTIVES
i. To identify coping skills used by parents of children affected with cerebral palsy
ii. To establish parent’s attitude towards children affected with cerebral palsy
iii. To assess knowledge of parents towards children affected with cerebral palsy
iv. To identify common causes of cerebral palsy among children attending occupational therapy clinic
in Maragua sub county hospital
1.4 RESEARCH QUESTION
What are the parental coping skills towards children affected with cerebral palsy attending
occupational therapy clinic at Maragua sub county hospital
1.5 BACKGROUND INFORMATION
Cerebral palsy is a static neurologic condition resulting from brain injury that occurs before cerebral
development is complete. Because brain development continues during the first two years of life,
cerebral palsy can result from brain injury occurring during the prenatal or postnatal periods.
Parents of children with cerebral palsy had low levels of quality of life and mental health. Self-
efficacy was related to most outcomes, whereas coping strategies assessed was significantly related
to the outcome.
Self-efficacy should be a key element in interventions addressed to parents of children with CP to
elicit a process of empowerment that can improve the wellbeing of the family as a whole.
Although professionals are gradually becoming aware of the important role of the family in a child’s
life and initiatives to implement concepts of Family Centred Services (FCS) into rehabilitation
practice have started. Aim of this is gain knowledge about the process of adaptation of parents of
children with CP. (Guyard A et al)
Presentation of CP can be global mental and physical dysfunction or isolated disturbances in gait,
cognition growth or sensation. It’s the most common childhood physical disability and affects 2 to
2.5 children per 1000 born in the US. The goals of treatment are to improve functionality and
capabilities towards independence. Multispecialty treatment team should be developed around the
needs of each patient to provide continuously updated global treatment care plans. (Krigger K. N.,
2006)
Research conducted by Green L. B. And Hurvits EA, 2006 states that cerebral palsy is the leading
cause of childhood disability. This article reviews common presentations of CP and its possible
causes. Many treatment options available for CP with varying degrees of evidence and acceptance.
This article briefly reviews the psychosocial impact of this chronic disease on individuals and their
caregivers and family.
1.6 STUDY JUSTIFICATION
The physical and psychological health of parents is strongly influenced by child’s behaviour and care
giving demands. Child behaviour problems were an important predictor of parent wellbeing both
directly and indirectly through their effect on self-perception and family function. In families of
children with cerebral palsy strategies for optimizing parent’s physical and psychological health
include supports for behavioural management and daily functional activities as well as stress
management and self-efficacy. (Raina P. Et al)
This study is being done in a setup where they appear to be many persons suffering from cerebral
palsy as well as many developmental problems. The study findings may be used by research students
and other researchers and other stakeholders as a reference in the relevant studies. The policy
makers may also use the recommendations to develop policies that will greatly impact on cerebral
palsy and how parents will cope with the situation.
The study will also benefit the researcher by meeting the minimum requirements for the partial
fulfilment for the award of Diploma in KRCHN.
1.7 PROBLEM STATEMENT
Cerebral palsy is a disease that affects many people from all over the world and it’s the leading cause
of delayed milestones in which many parents find it difficult to cope up with. Therefore, the study
intends to assess parental coping strategies towards children affected with cerebral palsy.
CHAPTER TWO
LITERATURE REVIEW
2.1 INTRODUCTION
This chapter involves the systematic identification, location and analysis of documents containing
information that is related to the problem being investigated.
2.2 COPING SKILLS USED BY PARENTS
Cerebral palsy describes a group of disorders of the development of movement and posture causing
activity limitations that are contributed to non – progressive disturbances that occurred in the
developing foetal or infant brain.
At present, the general perception of the family as the social unit within which to rear children has
led to the development of family centred approaches so as to gain knowledge about the process of
adaptation of parents of young children with CP.
Majority of parents of children with CP have come to terms with this diagnosis by the time their
children is 18 months old. Most parents with a resolved main status show changing patterns of
resolution strategies to their child’s diagnosis suggesting that resolution is an ongoing process. A
child with CP in a family may lead to parents perceiving restrictions in family participation.
(Geneeskunde proefschriften,2019). Studies indicate that parents of children with CP are more likely
to experience marital discord and divorce. The care that a disabled child requires can be much
greater than that of a normally developing child therefore places extra care demands on parents.
This in turn can lead to high stress levels which have the potential to cause conflict within a marriage
and may explain why a large number of children with special needs may live in a one parent
household. (Edworthy A, 2005)
Mothers of disabled children involved in a study reported that they viewed their partners as a source
of emotional support and strength. It has also been evidenced that a supportive marital relationship
can have impact on the care of the child. It is suggested that if a spouse offers emotional and
practical support in the care of the child. This has potential to affect their partner’s perception of the
disabled child. If the spouse discusses the child in a positive manner this may lead to acceptance and
in turn this could be better care for the child. (Sobey D, 2013)
Guyard A et al conducted research which showed that time spent caring for the child appears to be
an important factor that depends on the child’s autonomy. However, the child’s behavioural
problems influence the impact experienced by the parents. The level of intellectual impairment also
has a negative influence on family relationship and on parents’ psychological wellbeing. The child’s
developmental stage seems to be related to the level of the parent impact but there is no
agreement on the dimensions involved.
Studies indicated that parents with a disabled child may be consumed with their own emotions and
may feel unable to discuss the way they are feeling with their partners. A family’s cultural heritage
can affect the style content of their support for their child with CP. (Cooley, 2012)
A study showed that parents of a child with CP face arrange of stressors depending on their child’s
age developmental and functioning. At the time of initial diagnosis, parents typically grieve when
confronted with the fact that their child is not developing normally and life will present ongoing
struggles for them and their child. (Blackman JA Cobbls, 2014)
A study showed that coping strategies that focus on problem solving in general have more positive
adjustment outcomes than coping strategies that focus on denial, escape and avoidance of
difficulties. (Abbeduto et al, 2014, Gavida, Payne and Schoeman, 2010, Judge, 2018)
2.3 PARENTS ATTITUDE TOWARDS CHILDREN AFFECTED WITH CP
Studies indicate that parents of a child with CP face a range including the desire to help their child
function as normally as possible. The trend towards family focused rather than simply technical or
short-term rehabilitation and interventions focused only on the child, have improved outcomes and
reduced family stress. (Blackman JA Cobbls, 2014)
Some parents cannot cope with the situation of their child hence they must decide whether to give
the child up for adoption or to place him in an institution. The family may find it difficult to entertain
friends at home or to visit others.
Transportation may become difficult if special equipment must be transported with the child. A
common initial reaction of parents is disappointment and grief over the death of a dream.
Parents may see dozens of professionals try new diets, drugs and therapies all in the hope their child
will become normal. Eventually, most parents learn to accept their child, develop tolerance for
his/her disabilities, appreciation for his uniqueness and come to have pride in his assets.
Parents greatly reduce the guilt and stress by sharing experiences with parents who have similar
problems. (Marcia A Cohen)
A study showed that the level of intellectual impairment has a negative influence on family
relationships and on parents’ psychological wellbeing. The child’s development stage seems to be
related to the level of parental impact. (Guyard A et al)
A study stated that coping strategies that focus on problem solving in general have more positive
adjustment outcomes than coping strategies that focus on denial, escape and avoidance of
difficulties. (Abbeduto et al, 2014, Gavida-Payne and Schoeman, 2010, Judge, 2018).
2.4 KNOWLEDGE OF PARENTS TOWARDS CHILDREN AFFECTED WITH CP
Parents have reported that they get a lot of information from attending support groups.
Researchers found that the parents they questioned described support groups as providing a forum
in which parents can discuss their concerns and exchange ideas with each other.
Researchers found in a review of literature. That the family stress and coping that mutual help
groups not support their members but are also focused on action and changing policies and attitudes
that affect what they discuss as a problem situation, (Toro PA Wellsburg KP Guare J and Lieberstein
NL, 2013)
People with Cp their families, careers and service providers are on a lifelong quest for knowledge.
On diagnosis families first ask “why did this happen?” then “what does the future holds for my
child ?” then “how can I make the best life for my child?” At every stage of their child’s life the
family’s knowledge needs change. (Baldry E Brattle, 2018)
Parents of children with CP want to help their child but they need information, guidance and
practical support to facilitate their decision making regarding the use of conventional treatment. A
clearer understanding of factors predictive of optimal outcomes will enable resources to be Targeted
effectively. (Jo Wray)
Parents of children with CP face many problems encountered by their disabled children, the aim of
the present paper is to report the current knowledge on the parental impact.
Research conducted showed that parental impact dimensions were distinguished and they focused
on seven dimensions that is; time spent, occupational restrictions, social relationships. family
relationships, psychological wellbeing, physical health and financial burden.
It seems that time spent caring for the child appears to be an important factor that depends on the
Child’s autonomy. (Guyard A et al)
2.5 COMMON CAUSES OF CP
Birth complications including asphyxia are Currently estimated to account for about 6% of patients
with congenital CP including birth after fewer than 32 weeks gestation, low weight, IUGR,
intracranial haemorrhage and trauma.
In about 10 – 20% of patients, CP is acquired postnatal, mainly because of brain damage from
bacterial meningitis, viral encephalitis hyperbilirubinemia, motor vehicle collisions fall (Karen W.
Krigger MD; MED AM Fam physician, 2006 Jan.)
Shahnaz Hamid, Zafar Abdul Mueed conducted a study about CP in which he said that it was a major
Cause of morbidity in the country. Although birth asphyxia plays a major role in its aetiology there
are a small percentage of children that have sustained a prenatal ischemic stroke. This holds true
where children present after 3 – 4 months of age to the paediatrician with a history of weakness on
one side.
According to Mr. Johnston and Hoon AH JI, 2006, CP is a group of disorders of movement and
posture resulting from non-progressive disturbances of the foetal or neonatal brain. More than 80
infants both prenatal and postnatal causes contribute to the condition. It results from vulnerability
of immature oligodendrocytes before 32 weeks of gestation.
Asphyxia around the time of birth in term infant’s accounts for less than 15% of CP in developed
countries but the incidences is high in underdeveloped areas.
Clinical trials indicate that hypothermia reduces death or disability in term infants following asphyxia
and basic research suggests that this approach might be combined with pharmacological strategies
in future.
According to David D. W., 1997, CP is a non-progressive disorder of motor function. It has been
estimated that 17 to 60% of the cases of CP have no known prenatal or neonatal complications.
Undocumented antenatal events may cause brain damage or increase the infant’s vulnerability to
future events. Its incidences in the preterm population have increased with improving survival of the
low birth weight.
Despite improvements in prenatal medicine. The rate of CP has increased over the last two decades.
Evidence suggests that 70% to 80% 0f cases of CP are due to prenatal factors and that birth asphyxia
plays a relatively minor role chorioamnionitis or intrauterine infection has been implicated as a
potential cause of CP. (Yvonne W. Wu MD, MPH, John M Catford Jr Md PhD)
Chapter 3
Research methodology
3.1 Introduction
This chapter focuses on location of the study research design study population, sample and sampling
procedure, researching instruments, data collection procedure and methods of data analysis
background of study area
3.2 Geography of study area
This study was undertaken in Maragua sub county hospital in the occupational therapy clinic located
in Murang’a county. The consistency headquarters is about 60 kilometres from Nairobi.
3.3 Ethnic distribution
The predominant group of people is kikuyu 65% Masaai 20% luos 5% Somalis and Kamba’s 5%
3.4 Climate
The constituency experienced 2 rainy seasons with long rain starts from May and short rains starting
from October. The rain full distribution varies.
3.5 Study population
This is the universal set of the study of real or hypothetically set off people depending on the
subject to which researcher wishes to generate results (Aurine and Hakama, 2014)
According to Maragua sub county Hospital, occupational therapy clinic information from the records,
had a total number of 576 clients who attended the clinic in a year205 patients remained for follow
up in the facility well the rest word transferred to be followed in their nearby facility.
3.6Study variables
Variables are measurable factors through the process of operationalization. Independent variables
and dependent variables. Independent variables were age, sex while dependent variable was clients
at occupational therapy clinic.
3.7 Study design
A cross section of descriptive study adopting both qualitative and quantitative approaches to data
collection analysis and presentation which would explore on assessment on coping skills used by
parents with children affected with cerebral palsy. Parents with children affected with cerebral palsy
were taken to give necessary information.
3.8 Sample determination
This displays the number interviewed in the study. The rule of thumb formula by fisher et al (1998)
was used to obtain the sample size.
N= the desired sample size (if the population> 10000)
Z= the standard normal deviation at the required confidence level (1.96)
P= the proportion in the target population estimated to have characteristics being measured.
Q= 1-P standardized at 0.5
D= level of statistical significance usually 0.05
Since the target population was less than 10000 the required sample size was smaller hence the
following formula was used to get the desired sample
nf= n/1+n/N
where;
nf= the desired sample size where the population is <10000
n= the desired sample size when the population >10000
N= the estimated sample size from the study population = 400
nf = 384/1+384/205
nf = 384/2.87 = 134
The desired sample size was 134 respondents but due to limited time the researcher was not able to
cover 134 respondents hence 20% was used to cover and represent the entire study population.
3.9 DATA COLLECTION INSTRUMENT
The researcher used both primary and secondary method of data collection. For primary data, a
structured questionnaire was used. The questionnaire had both open and close-ended questions.
For secondary data books, magazines, newspapers, and other documents related to cerebral palsy.
3.10 DATA COLLECTION PROCEDURE
Data was collected through administration of questionnaires to the respondents and they were
allowed a maximum of 30 minutes to fill questionnaires was collected and checked for
completeness.
3.11 DATA ANALYSIS TECHNIQUES
This is the process of packaging the collected information putting in order and structuring main
components in a way that the major findings can be easily and effectively communicated (Kombo
and Tromp, 2014). In this study research was analysed based on each questionnaire.
3.12 ETHICAL CONSIDERATION
Before collection of data the research process was approved by the research supervisor Madam
Faith Korir. The potential respondents were issued with consent forms whish described the type of
study, purpose of the study and their rights including emphasis on respondents, confidentiality.
Patients were enrolled in the study once informed consent was received. All information about
clients was handled with utmost confidentiality and only used for intended purpose.
3.13 IMPLICATIONS OF THE STUDY TO NURSING PRACTICE
The study is significant to the entire nursing profession because nurses are among other Professional
in the health care delivery system. The nurses need to understand the coping Strategies, knowledge,
attitude and major contributing factors parents know towards their Children affected by CP so as to
clarify to the parents what they need to know. This will lead to the parents who may need
clarification or further management to seek medical attention rather than staying with the child at
home while unattended.
The study also recommends the training of more nursing officers on special needs so as to assist the
ones already trained. This will motivate them to give quality care to the parents of affected children
with CP and referring them promptly where necessary. The nurses will also act as link between the
ministry of health in collaboration with non-governmental organizations as they organize for
seminars and workshops in the community. This is to educate the parents so that they can change
their attitude, improve on their coping strategies and to know that CP is not as a result of witchcraft
or curse.
The study will also promote job satisfaction among the nursing staff to see the parents with affected
children given the correct therapy and education on CP. With the reduced number of birth
complications the workload for nurses will also reduce because the nurses will care for less patients
with CP. In spite of the increasing number of CP rate, the nurses are compelled to organize for school
health programmes. These are avenues where they can health educate on the attitude towards
people with disabilities so that people will change towards them. The teachers and guardians are
educated through such programmes so that they can help in reducing the stigma associated with CP
disabilities hence caring for their health and the affected.
CHAPTER FOUR: STUDY FINDINGS
4.1 Introduction
This chapter presents the findings on coping strategies used by parents of children with cerebral
palsy attending the occupational therapy clinic at Maragua Level 4 Hospital. Data were analyzed and
presented using descriptive statistics, tables, and pie charts for clarity.
---
4.2 Demographic Characteristics of Respondents
Table 4.1: Demographic Information of Parents (n = 50)
Figure 4.1: Gender Distribution of Respondents
(Pie Chart)
Female: 76%
Male: 24%
Figure 4.2: Age Distribution of Respondents
(Pie Chart)
18–30: 20%
31–40: 50%
41–50: 24%
51+: 6%
---
4.3 Coping Strategies Used by Parents
Parents reported using a variety of coping strategies, categorized into problem-focused and
emotion-focused approaches.
Table 4.2: Reported Coping Strategies
Figure 4.3: Coping Strategies Used by Parents
(Pie Chart: Problem-Focused vs Emotion-Focused)
Problem-focused: 68%
Emotion-focused: 32%
Figure 4.4: Specific Coping Mechanisms
(Bar Chart)
Acceptance – 60%
Social Support – 56%
Religious Coping – 48%
Avoidance/Denial – 20%
---
4.4 Challenges Faced by Parents
Table 4.3: Key Challenges Experienced
Figure 4.5: Common Challenges Among Parents
(Pie Chart)
Financial strain: 60%
Emotional stress: 52%
Social support issues: 44%
Fatigue/time: 36%
Stigma: 24%
---
4.5 Summary of Key Findings
A majority of parents (68%) adopt problem-focused coping strategies, while 32% rely more on
emotional responses.
Acceptance, social support, and religious coping are the most commonly used strategies.
Financial burden and emotional stress are the most cited challenges in caregiving.
Most respondents were female (76%) and within the 31–40 age group.
4.6 Discussion
The findings underscore the multifaceted challenges faced by caregivers of children with CP in
Maragua Sub-County. The psychological, financial, and social burdens align with those reported in
urban centers like Nairobi, suggesting that these issues are pervasive across different settings in
Kenya.
The reliance on religious practices and social support networks highlights the cultural context of
caregiving in Kenya, where communal and spiritual resources play a crucial role in coping. However,
the persistent challenges in accessing adequate healthcare services and information point to
systemic issues that need to be addressed.
4.7 Conclusion
Caregivers of children with cerebral palsy in Maragua Sub-County employ a range of coping
strategies, including active problem-solving, religious practices, and reliance on social support
networks. Despite these efforts, they face significant challenges, particularly in accessing information
and healthcare services. Addressing these issues requires a multifaceted approach, including
community education, improved healthcare infrastructure, and financial support mechanism.
5 : CHAPTER FIVE: SUMMARY OF FINDINGS
5.1 Summary of Findings
This study assessed the coping strategies employed by parents of children diagnosed with cerebral
palsy (CP) who attend the occupational therapy clinic at Maragua Sub-County Hospital.
Demographics: Most participants were mothers, aged between 25–45 years, with low to middle
socioeconomic backgrounds. A majority had completed primary or secondary school.
Coping Strategies:
Problem-focused coping was common, including seeking information and adjusting routines.
Emotion-focused coping such as prayer, acceptance, and avoidance was widely used.
Social support from extended families and religious groups was vital.
Challenges Faced:
Psychological stress and caregiver burnout were prevalent.
Financial hardship limited access to consistent therapy and assistive devices.
Stigma and societal misconceptions created emotional burdens.
These results suggest that while caregivers actively use coping mechanisms, systemic and societal
challenges limit their effectiveness.
5.2 Conclusions
Parents rely heavily on emotion- and spirituality-based coping mechanisms, reflecting the socio-
cultural context of rural Kenya.
Access to professional psychological support is limited, resulting in reliance on informal networks.
Awareness and education about CP are lacking, increasing the burden of stigma and isolation.
Healthcare services are under-resourced, affecting the frequency and quality of occupational
therapy interventions.
5.3 Recommendations
For Healthcare Providers:
Develop structured support groups and counseling services for caregivers.
Train occupational therapy staff to provide basic psychoeducation on coping strategies.
For Policy Makers:
Increase funding for rural disability services.
Incorporate disability awareness programs in community outreach.
For Future Research:
Conduct longitudinal studies to track coping over time.
Explore the experiences of fathers and other caregivers, who are underrepresented.
REFERENCES
1. Cerebral Medicine Physical and Rehabilitation Clinic of North America. Edworthy A
2005 18(4) 859-82.
2. David D. W., 2017. Living with a disabled Child
3. Geneeskund Proefschriften, 2019 –A couple guide.
4. Guyard et al, Journal of learning.
5. Johnston Mv and Hoon AH Jr, 2016. Developmental Disabilities.
6. Krigger K. W., 2006. American Family Physician 3(1) 91-100.
7. Neonatal network 16(8) 7-12.
8. Neuromuscular Medicine 8(4) 435-50.
9. Odding E. Roebroeck M. E. And Stam H. J. The epidemiology of CP disability and
Rehabilitation 28(4) 183-91.
10. Sankar and Madhur N, 2005. Indian Journal of Paediatrics 72(10) 865-8.
11. Yvonne W. Wu MD John M Calford Jr MD PhD. Arch Paediatrics
CONSENT FORM
TOPIC ASSESSMENT ON COPING SKILLS USED BY PARENTS WITH CHILDREN WITH CEREBRAL PALSY
ATTENDING OCCUPATION THERAPY CLINIC AT MARAGUA SUB COUNTY HOSPITAL
I am KIBARA ALEX MUGWERU a student of Imperial College Of Medical And Health Sciences pursuing
diploma in Community Health Nursing.
I kindly request you to participate in the above study. The results from the study shall be kept
confidential and shall be used to establish strategies. Your participation shall be greatly appreciated
and it will be at no cost.
There is no penalty if you do not participate in the study and if you participate then you will be free
to withhold information required in the study if you wish so. Initials shall be used instead of your real
names.
STATEMENT OF CONSENT
I……………..……………………………………………………. have read and understood this document and
therefore I agree to take part in this study.
Signature……………………………………………… Date…………………………………………………..
RESEARCH QUESTIONNAIRE
A questionnaire used to determine the coping skills used by parents with children affected with
cerebral palsy attending occupational therapy clinic in Maragua sub county hospital.
INSTRUCTIONS
i. Attempt all questions
ii. Do not write your name
iii. All information obtained will be treated with confidentiality and for the purpose of the student
iv. Use tick in the spaces provided
1. Sex of the parent
a. Male [ ]
b. Female [ ]
2. How old are you?
i. 18-25 [ ]
ii. 26-32 years [ ]
iii. 33-39 years [ ]
iv. 40 years and above [ ]
3. Child sex
i. Male [ ]
ii. Female [ ]
4. How old is your child?
a. Below one year [ ]
b. 1-5 years [ ]
c. 6-11 years [ ]
d. 12-15 years [ ]
5. Do you know what your child is suffering from?
a. Yes [ ]
b. No [ ]
6. Do you understand the term cerebral palsy?
a. Yes [ ]
b. No [ ]
7. Have you accepted your child?
a. Yes [ ]
b. No [ ]
8. Have you been educated on cerebral palsy?
a. Yes [ ]
b. No [ ]
9. If yes, specify the source of information.
a. Health worker
b. Neighbours/friends
c. Parents with children affected with cerebral palsy
d. Other source, specify…………………………………………..
10. Do you have any positive statements to make about caring for a child with cerebral palsy?
a. Yes [ ]
b. No [ ]
11. If No, explain why?
………………………………………………………………………………………
12. Do you utilize any formal community resources as a parent caring for a child with cerebral palsy?
a. Yes [ ]
b. No [ ]
13. If no, explain why?
……………………………………………………………………………………………………
14. Rate your attitude level towards your child
a. Positive [ ]
b. Negative [ ]
15. If negative, what strategies do you use to cope up with?
ITEM DESCRIPTION QUANTITY UNIT COST TOTAL[Kshs]
Stationaries Pen 10 25 250
Pencil 5 20 200
Note book 5 60 300
Paper
Binding
Writing
Photocopying 3 reams 400 1200
Type setting and _ 50 pages 30 1,520
Printing
Transport, 2 months Daily travels, 3,000
accommodation lunch
and lunch
Research 1 week 7 sessions 1000
assistant
Miscellaneous - _ 500
TOTAL 7970
Month Dec Jan Feb March April May
Activity 2024 2025 2025 2025 2025 2025
Concept
writing and
presentatio
n for
approval
Proposal
developme
nt and
approval
Ethics
review and
approval
Data
collection
and
analysis
Research
writing,
corrections
and
presentatio
n
Final
research
submission
for marking
