Navigating Modern Environments: Challenges in Raising Children with Cerebral Palsy and Autism
Abstract
Background: Urbanization significantly shapes the landscape of healthcare accessibility, often creating disparities for children with neurodevelopmental disorders. Children with Autism Spectrum Disorder (ASD) and Cerebral Palsy (CP) require complex, long-term care, which places a heavy burden on the socio-demographic and psychosocial stability of their families depending on their residential environment.
Objectives: To examine the impact of territorial factors and urbanization on the socio-demographic profiles and service accessibility of families raising children with ASD and CP in Northeastern Bulgaria.
Methods: A cross-sectional study was conducted using structured questionnaires to collect data on socio-demographic characteristics and access to therapies. Data from 146 parents (ASD n = 102; CP n = 44) were analyzed using Jamovi software (v2.6.23). Statistical significance was set at p < 0.05.
Results: Findings indicate that diagnosis is significantly associated with the type of settlement; 14.4% of families reside in rural areas (p = 0.001), where access to specialized healthcare is severely limited compared to urban centers. Higher education was more prevalent among mothers (41.5%) than fathers (26.3%), with CP parents showing higher educational attainment. Financial strain was more acute in the ASD group (4.3% below minimum income). Notably, 32.9% of parents are single caregivers, significantly more frequent in the CP group (70.5% vs. 16.7%, p < 0.01). While only 28.8% manage without extra support, 37.0% rely on personal assistants (p < 0.01), highlighting the critical need for institutional support in urbanized regions.
Conclusions: Urbanization does not inherently guarantee equitable access to care. Families in less urbanized or peripheral areas face significant territorial and social insecurity. Public health policies must address these regional disparities by implementing targeted support systems. Targeted policies are vital to reduce regional health disparities.
Key messages: • Urban-rural disparities significantly limit healthcare access for families of children with CP and ASD, necessitating localized public health interventions.
• Socio-economic vulnerability, especially among single caregivers and rural residents, highlights the need for integrated social and territorial health policies.
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BibTeX
@article{toneva2026navigating,
title = {{Navigating Modern Environments: Challenges in Raising Children with Cerebral Palsy and Autism}},
author = {AB Toneva and SE Hadzhieva and RS Braykova and RH Chamova and SP Nicolova and RZ Pancheva},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1804},
url = {https://doi.org/10.1093/eurpub/ckag169.1804},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Navigating Modern Environments: Challenges in Raising Children with Cerebral Palsy and Autism
AU - AB Toneva
AU - SE Hadzhieva
AU - RS Braykova
AU - RH Chamova
AU - SP Nicolova
AU - RZ Pancheva
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1804
UR - https://doi.org/10.1093/eurpub/ckag169.1804
AB - Background: Urbanization significantly shapes the landscape of healthcare accessibility, often creating disparities for children with neurodevelopmental disorders. Children with Autism Spectrum Disorder (ASD) and Cerebral Palsy (CP) require complex, long-term care, which places a heavy burden on the socio-demographic and psychosocial stability of their families depending on their residential environment. Objectives: To examine the impact of territorial factors and urbanization on the socio-demographic profiles and service accessibility of families raising children with ASD and CP in Northeastern Bulgaria. Methods: A cross-sectional study was conducted using structured questionnaires to collect data on socio-demographic characteristics and access to therapies. Data from 146 parents (ASD n = 102; CP n = 44) were analyzed using Jamovi software (v2.6.23). Statistical significance was set at p < 0.05. Results: Findings indicate that diagnosis is significantly associated with the type of settlement; 14.4% of families reside in rural areas (p = 0.001), where access to specialized healthcare is severely limited compared to urban centers. Higher education was more prevalent among mothers (41.5%) than fathers (26.3%), with CP parents showing higher educational attainment. Financial strain was more acute in the ASD group (4.3% below minimum income). Notably, 32.9% of parents are single caregivers, significantly more frequent in the CP group (70.5% vs. 16.7%, p < 0.01). While only 28.8% manage without extra support, 37.0% rely on personal assistants (p < 0.01), highlighting the critical need for institutional support in urbanized regions. Conclusions: Urbanization does not inherently guarantee equitable access to care. Families in less urbanized or peripheral areas face significant territorial and social insecurity. Public health policies must address these regional disparities by implementing targeted support systems. Targeted policies are vital to reduce regional health disparities. Key messages: • Urban-rural disparities significantly limit healthcare access for families of children with CP and ASD, necessitating localized public health interventions. • Socio-economic vulnerability, especially among single caregivers and rural residents, highlights the need for integrated social and territorial health policies.
SN - 1101-1262
SN - 1464-360X
ER -