Feasibility, acceptability, and preliminary impact of the WHO-Caregiver skill training (CST) in a low-income clinical setting: a mixed-methods evaluation

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BACKGROUND: The intensive demands of caring for children with developmental disorders (DDs) result in diminished quality of life (QoL) and increased family burden, particularly in low- and middle-income countries (LMICs), such as Ethiopia, where access to specialized healthcare and caregiver support is limited. This study aimed to evaluate the feasibility, acceptability, and preliminary impact of the World Health Organization-Caregiver skill training (WHO-CST) within a clinical setting. METHODS: A convergent parallel mixed-methods study design was employed. The qualitative data included 19 caregiver interviews and three focus group discussions with 20 facilitators examining program acceptability and implementation barriers, and the data were analyzed thematically. The quantitative data included 127 caregivers who completed pre- and post-intervention assessments, which were analyzed using paired t-tests and regression models (p < .05). RESULTS: The qualitative analysis revealed four main themes: program acceptability, implementation challenges, effective strategies and recommendations. After the intervention, the caregivers exhibited better self-care and reduced their reliance on physical punishment. They also reported improvements in their children's communication skills and adaptive and challenging behaviors. Factors such as resource shortage and time constraints were identified as implementation barriers. Among those who completed the follow-up, 100% attended seven sessions or more. The quantitative analysis showed significant improvements in the psychological (Mdiff =3.01, t (126) =2.37, p = .019) and environmental (Mdiff =4.97, t (126) =4.19, p< .001) domains. However, the improvement in the overall quality of life (QoL) (Mdiff =1.74, t (126) =1.96, p= .052) and the reduction in the overall burden score (Mdiff = -.86, t (126) = -1.09, p= .277) were marginal and did not reach statistical significance. CONCLUSION: The WHO-CST is a feasible and acceptable intervention in Ethiopian clinical setting. It is associated with potential improvements in parenting style, self-care, and selected QoL domains among caregivers. By utilizing psychiatry residents as facilitators, the study implemented a service integration and capacity-building model to address gaps in a resource-limited setting. The findings may inform future implementation strategies and policy development in similar low-resource settings. Future evaluations should explore the cost-effectiveness and institutional support required to maintain the WHO-CST as standard care. CLINICAL TRIAL NUMBER: Not applicable.

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