{
  "abstract": "Background: The implementation of caregiver-led training programmes for complex childhood-onset conditions like cerebral palsy is challenging as multiple factors influence outcomes, particularly in rural, resource-constrained settings. Understanding the perspectives of the caregivers and professionals implementing programmes is important to identify practical, cultural, and logistical factors that influence programme outcomes. This qualitative study explored the facilitators and barriers encountered during the implementation of a caregiver-led training programme in rural Mangochi, Malawi. Methods: In-depth interviews were conducted with physiotherapists and caregivers of children with cerebral palsy who participated in a seven-week feasibility trial of the Malamulele Onward Carer-2-Carer Training programme in August 2023. Semi-structured interview guides informed by the Consolidated Framework for Implementation Research were used to conduct the interviews. The interviews were audio-recorded and transcribed verbatim. Data were managed using NVivo and analysed thematically. An abductive analytical approach was used, whereby themes were initially generated inductively and later interpreted deductively within the framework to enhance conceptual depth. Results: Facilitators of programme implementation included the integration of training into daily caregiving routines, active caregiver engagement, and the logistical support provided by a community-based organisation. A key finding was the unique contribution of expert caregivers, who facilitated sessions using shared language, lived experience, and emotional connection, which enhanced caregiver participation and trust. The expert caregivers’ ability to mobilise local resources further supported programme delivery. Barriers included time constraints for covering some modules, slow learning and particular skill acquisition challenges among older caregivers and external factors such as poor access to transportation and limited family support for home practice. While both expert caregivers and therapists effectively facilitated the programme, expert caregivers encountered occasional challenges with content presentation when delivering sessions. Conclusion: Reflections from caregivers and physiotherapists in rural Malawi highlighted the strengths of integrating lived experience into programme delivery. Expert caregivers fostered engagement and trust, helping to address participant learning challenges. However, continued mentorship, improving physical access and social support remain crucial for sustaining caregiver-led training programmes and maximising their impact on children with cerebral palsy and their families.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Rehabilitation Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi",
    "Division of Community Paediatrics, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Witwatersrand Johannesburg, South Africa",
    "Department of Physiotherapy, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Takondwa Connis Bakuwa"
    },
    {
      "affs": [
        1
      ],
      "name": "Gillian Saloojee"
    },
    {
      "affs": [
        2
      ],
      "name": "Wiedaad Slemming"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/evdmqd44xmnth.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0356240",
  "fulltext_url": null,
  "id": "evdmqd44xmnth",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0356240",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "3600|Health Policy Implementation Science"
    ],
    [
      "plos",
      "/Biology and life sciences/Neuroscience/Cognitive science/Cognitive psychology/Language"
    ],
    [
      "plos",
      "/Biology and life sciences/Neuroscience/Cognitive science/Cognitive psychology/Learning/Human learning"
    ],
    [
      "plos",
      "/Biology and life sciences/Neuroscience/Learning and memory/Learning/Human learning"
    ],
    [
      "plos",
      "/Biology and life sciences/Psychology/Cognitive psychology/Language"
    ],
    [
      "plos",
      "/Biology and life sciences/Psychology/Cognitive psychology/Learning/Human learning"
    ],
    [
      "plos",
      "/Ecology and environmental sciences/Sustainability science"
    ],
    [
      "plos",
      "/Engineering and technology/Transportation"
    ],
    [
      "plos",
      "/Medicine and health sciences/Health care/Caregivers"
    ],
    [
      "plos",
      "/Medicine and health sciences/Neurology/Cerebral palsy"
    ],
    [
      "plos",
      "/People and places/Population groupings/Age groups/Children"
    ],
    [
      "plos",
      "/People and places/Population groupings/Families/Children"
    ],
    [
      "plos",
      "/Social sciences/Psychology/Cognitive psychology/Language"
    ],
    [
      "plos",
      "/Social sciences/Psychology/Cognitive psychology/Learning/Human learning"
    ],
    [
      "plos",
      "/Social sciences/Sociology/Human families"
    ]
  ],
  "openalex": "W4415713465",
  "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0356240&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-01",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/evdmqd44xmnth.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:02Z",
      "native_id": "10.1371/journal.pone.0356240",
      "source": "plos",
      "url": "https://doi.org/10.1371/journal.pone.0356240"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "plos:neuroscience",
      "subfield": "neuroscience"
    }
  ],
  "title": "Facilitators and barriers to the implementation of a caregiver-led training programme for caregivers of children with cerebral palsy in rural Malawi",
  "title_text": "Facilitators and barriers to the implementation of a caregiver-led training programme for caregivers of children with cerebral palsy in rural Malawi",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:18:02Z",
  "url": "https://research.draconitic.com/paper/evdmqd44xmnth",
  "venue": "PLOS One",
  "versions": []
}