Participation of Fathers and Siblings in Home Rehabilitation Programmes for Children with Neuro-developmental Delay: Perspectives of Fathers in Bulawayo, Zimbabwe

Purpose
To assess participation levels of fathers and siblings in home-based rehabilitation for children with neuro-developmental delay (NDD) in Bulawayo, Zimbabwe, and identify facilitators and barriers.

Materials and Methods
A concurrent mixed-methods cross-sectional design with a dominant quantitative component and a supplementary qualitative component was used. Data were collected from 196 fathers of children with NDD at two hospitals using a questionnaire. Quantitative data were analysed using descriptive statistics and logistic regression (α = 0.05) in Stata 17.0, while open-ended responses were thematically analysed in NVivo 12 using a deductive approach informed by the Social Ecological Model.

Results
Only 35 (17.9%) fathers and 20 (10.2%) siblings consistently participated. Fathers with tertiary education participated more (AOR = 6.4; 95% CI: 1.9–22.1; p = 0.003), as did fathers of male children (AOR = 2.8; 95% CI: 1.3–6.1; p = 0.009). Facilitators included ability to manage disability-related challenges and access to information. Barriers included emotional strain, work demands, and exclusion from sessions. Sibling participation was facilitated by parental supervision, play-based activities, and professional support, while barriers included school obligations and cultural norms.
Conclusions
Modifiable factors affect father and sibling participation, highlighting the need for inclusive family-centred rehabilitation policies and practices.

IMPLICATIONS FOR REHABILITATION:

Active inclusion of fathers and siblings in neuro-developmental home-based rehabilitation programmes can improve family engagement and child developmental outcomes.

Cultural beliefs and entrenched gender-based roles should be addressed when designing inclusive rehabilitation strategies.

Clinicians should be trained in family-centred practices that promote the participation of fathers and siblings regardless of participant characteristics.

Home-based interventions should utilise flexible, low-literacy tools to support engagement across diverse households.