1419-Article Text-3631-1-10-20220414

Malaysian Journal of Social Sciences and Humanities (MJSSH) (e-ISSN : 2504-8562)
2022, Volume 7, Issue 4, e001419

DOI: https://doi.org/10.47405/mjssh.v7i4.1419
The Effectiveness of Cerebral Palsy Support Intervention on

Perceived Social Support Among Caregivers of Children with
Cerebral Palsy in North-Eastern Region, Malaysia
Siti Aisyah Zakaria1 , Azriani Ab Rahman2* , Mohd Ismail Ibrahim3,

Raishan Shafini Bakar4 , Mohd Zulkifli Abdul Rahim5 , Nor Haslina Mohd6 ,
Nor Azni Yahaya7
1Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150
Kubang Kerian, Kelantan, Malaysia.
Email: acah83@gmail.com

Email: azriani@usm.my

Email: ismaildr@usm.my
4Department of Psychiatry, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian,
Kelantan, Malaysia.
Email: raishanshafini@usm.my
5School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Email: mdzul@usm.my
6School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
Email: nhaslina@usm.my
7Hospital Raja Perempuan Zainab II, 15586 Kota Bharu, Kelantan, Malaysia.
Email: drnorazni@moh.gov.my
ABSTRACT
CORRESPONDING Cerebral palsy (CP) is a lifelong disorder that requires a
AUTHOR (*): fulltime commitment from the caregivers. Due to the
Azriani Ab Rahman complexity of care and complications associated with CP, the
(azriani@usm.my) caregivers of children with CP require a good social support.
This study aimed to determine the impact of CP support
KEYWORDS: intervention on caregivers perceived social support.This
Cerebral palsy quasi-experimental study involved caregivers of children
Caregivers with CP from community-based rehabilitation (CBR)
Social support centers. The intervention group (n=21) were given CP
Intervention Support intervention through provision of information and
Multidisciplinary team social support from a multidisciplinary team including
governmental, non-governmental organizations (NGO) and
CITATION: parents. It contains information enrichment workshop
Siti Aisyah Zakaria et al. (2022). The (IEW), caregivers support group (CSG), and WhatsApp
Effectiveness of Cerebral Palsy Support
Intervention on Perceived Social Support group. The control group (n=45) received only usual care.
Among Caregivers of Children with Factorial ANCOVA revealed that higher level of perceived
Cerebral Palsy in North-Eastern Region,
Malaysia. Malaysian Journal of Social
social support was observed in the intervention group at the
Sciences and Humanities (MJSSH), 7(4), end of the study. The intervention effect was significant after
e001419. six months post intervention when other variables were
https://doi.org/10.47405/mjssh.v7i4.1419
controlled (p = 0.031). Findings of this study highlighted the
favorable outcome of the CP Support intervention program
© 2022 by the authors. Published by Secholian Publication. This article is licensed under a Creative
Commons Attribution 4.0 International License (CC BY).
2
on the caregivers’ perceived social support through

provision of information and social support.
Contribution/Originality: This study contributes to the existing literature on the

importance of social support provided to caregivers of children with cerebral palsy. It
documents the effectiveness of social support intervention in improving perceived
social support among the caregivers which justifies the need of implementing family
centered care in a multidisciplinary approach.
1. Introduction
Raising a child with CP can be a challenging experience for caregivers due to movement
disorders and other multiple comorbidities such as feeding difficulties, epilepsy,
behavioral problems, osteopenia, osteoporosis, and functional gastrointestinal
abnormalities that may affect CP child’s dependency towards others (Krigger, 2006).
Despite CP is non-progressive, the lifelong health care needed in caring for a child with CP
poses the family members particularly parents as the most immediate caregivers towards
low health-related quality of life (HRQOL), predisposing them to depressed and anxious
moods, and stress with higher maternal burden was recorded as compared to caregivers
of typically-developing children (Barlow, Cullen‐Powell, & Cheshire, 2006; Guillamón et
al., 2013; Lee, Matthews, & Park, 2019; Ozkan, 2018).
In Malaysia, the most common disability was learning disability followed by physical
disabilities (UNICEF, 2014). Due to the lack of systematic and reliable data collection and
compilation for children with disabilities, there was a discrepancy on the prevalence of
cerebral palsy reported by different ministries. As such, whilst the Department of Social
Welfare ranked physical disabilities as second highest after learning disabilities, a report
from the same department found that there was no new case of a cerebral palsy case
registered between 2011 and 2012 (UNICEF, 2014). Whereas the Ministry of Health
reported more than twenty percent increment in the detection of newly diagnosed
children with CP according to types of (UNICEF, 2014). The difference could be due to CP
can be reported as under physical or multiple disabilities categories. This suggests that
the figure reported is a gross underestimate as there is no proper national data nor
registry on the prevalence of CP children available in Malaysia (Isa et al., 2013). As the
registration of disability is on a voluntary basis (UNICEF, 2014), this leads to low
registrations, as parents do not register their children due to perceived stigma (Amar,
2008).
This study aimed to determine the impact of CP support intervention on caregivers

perceived social support by comparing the perceived social support score of caregivers
with CP children at pre-intervention and six months post-intervention.
2. Literature Review
Despite the current support delivered by the governmental and non-governmental

agencies in providing different means of benefit towards children with disabilities in
Malaysia, the caregivers still expressed their concern about having an intervention that
provides more social support especially support from other parents whose children had
a similar condition (Sy & Ms, 2011). The same challenges and everyday experiences they
face in handling their disabled children could establish the similarity between them, and
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they could support each other hand in hand. The caregivers also requested for
interventions that provide more information about their child’s growth and development,
child’s condition, how to handle the child’s behavior, how to play, talk or teach their child
as well as services presently available for their child (Sy & Ms, 2011). This is due to
caregivers reported that they have difficulty in obtaining information or have little access
to the information they needed because they failed to get help and have no idea where to
acquire the information needed (Sy & Ms, 2011).
To our knowledge, there is no local study specifically looking at the effectiveness of CP

intervention program which involves a group of multidisciplinary professionals in
medical, health field, social support organizations and parents as well as utilizing a social
media. Several studies proved the effectiveness of using social media (Shaw et al., 2015)
and involving multidisciplinary professionals (Hu et al., 2016) in improving health
education and social support to the target groups. Given the need for an intervention
study, provision of information and social support to the caregivers of children with CP
was deemed to be paramount that may empower them towards better care of CP children
and subsequently better quality of life. In light of this, we hoped this study would provide
an alternative strategy for improving the care of caregivers of children with CP. This study
may also increase stakeholder attention to and awareness of the benefits of implementing
family centered care (FCC) in a multidisciplinary approach in an attempt to improve the
caregivers perceived social support. It is intended to facilitate more powerful
collaborative program that may enhance the capacity building among the caregivers of
children with CP themselves and between the caregivers and the professionals.
3. Methodology
A quasi-experimental study was conducted among caregivers whose children were

registered with community-based rehabilitation (CBR) centers of Kelantan State Social
Welfare Department. Located in the northeast of Peninsular Malaysia, Kelantan state
comprises of ten suburb and rural districts. Purposive sampling was used to select the
CBR centers according to their respective districts for the ease of logistic and
transportation during the intervention program. The inclusion criteria of caregivers were:
(a) care givers of children with a known diagnosis of CP; (b) being 18 years of age or older
and (c) being identified as the caregivers who stay with the CP child/children under one-
roof and take care of CP child/children. Caregivers with known severe psychiatric
disorders were excluded from the study. Twenty-one caregivers were non-randomly
assigned in the intervention group and 45 caregivers participated in the control group.
The intervention group was given the CP support intervention program, while the control
group received usual care.
Ethical approval was obtained from the Universiti Sains Malaysia (USM) Human Research
Ethics Committee (Reference Code: USM/JEPeM/16110487). Additional approval to
conduct our study in the Community Based Rehabilitation (CBR) centers in the districts
were also granted by the Department of Social Welfare, Putrajaya [Reference Code: JKMM
100/12/5/2: 2017 / 039].
3.1. Instruments
A study pro–forma was used to collect data on the caregivers’ age, gender, marital status,
educational level, caregiver-child relationship, employment status, number of children,
number of CP children in the family, household income and whether they had extra help
4
from anyone in caregiving of the CP child. Caregivers were also asked to report on their
child's age, gender, age of diagnosis, educational level, and financial assistance received.
Level of stress among caregivers of children with CP was measured using the Malay-
translated version Perceived Stress Scale (PSS) – SF Questionnaire which was
administered prior to the intervention. The Cronbach‘s alpha coefficient to be acceptable
(α = .64) with high total test-retest reliability (r = 0.72) (Mazlan & Ahmad, 2012). It
consists of 10 items, each rated on a 5-point Likert scale from 0 (never) to 4 (very often).
Items inquire about degree to which the person has felt stress in various situations over
the past month. Question 4, 5, 7 and 8 represent positive items and were reverse scored
before summation of all the items score were made. Total score can be ranged from 0 to
40 and higher score indicates higher levels of perceived stress.
The unmet needs of caregivers were assessed using The Family Needs Survey (FNS),
developed by Bailey and Simeonsson (1988) and modified versions of it have been widely
used to measure family needs in cross sectional studies. Locally, the original version of
FNS was translated to Malay language by Sidek et al. (2011) in her study investigating the
unmet needs among children with disabilities (CWD) in Selangor. The FNS questionnaire
is a 35 item-scale and composed of six subscales; information, social support, community
services, explaining to others, financial support and family functioning. For each item, the
respondents were asked to choose one of the four response choices: 0= Not applicable, 1=
I definitely do not need help with this, 2= Not sure, 3= I definitely need help with this. The
total number of reported unmet needs was obtained by summing the number of item
rated 3 by the respondents. Respondents who answered 0, 1 or 2 were given score ‟0”
while respondents who answered 3 in the questionnaire were given score ‟1”. Scores
could range from 0 to 35 and higher scores indicated more unmet need. Based on her
study, the Malay validated FNS questionnaire was proven to have good internal
consistency with overall Cronbach’s alpha of 0.91 and subscales ranging from 0.74 to 0.88
as well as good face and content validity (Sukeri et al., 2017).
Multidimensional Scale of Perceived Social Support (MSPSS-M) is a self-administered

measure of social support administered to the intervention and control group before and
6 months after the intervention. It addresses the subjective assessment of social support
adequacy. It was designed to assess the perception of social support adequacy from three
different sources: Family, Friends and Significant Others. The MSPSS contains 12 items
using a 7-point Likert scale ranging from very strongly disagree (1) to agree (7) very
strongly. It is simple to use and can be quickly administered and scored (Zimet et al.,
1988). Each subscale was calculated for its mean score. For Significant Others subscale,
items 1, 2, 5, and 10 were summed across and divided by 4. For Family subscale, items 3,
4,8 and 11 were summed across and divided by 4 and rest of items 6, 7, 9, and 12 were
handled in similar way to give the mean score of Friends subscale. Summation across all
12 items then divided by 12 provides a total mean score for MSPSS. Validation study of
its Malay translated version demonstrated good reliability with coefficient α for the total
MSPSS was 0.89 and the subscales α’s of 0.94, 0.88 and 0.82, respectively for the
Significant Others, Friends and Family subscales. The parallel form of reliability and the
test– retest reliability after 1 week was also high (Ng et al., 2010).
3.2. CP Support intervention program
The provision of informational support was delivered through an intervention program,

known as CP Support program. To the best of our knowledge, there was no such similar
5
intervention study previously done at CBR centers where multidisciplinary experts from
different fields were brought into the community as an outreach program. These
distinguished experts were from medical and health, education department as well as
from social field. The 6-month CP Support program consisted of three major activities.
The first activity was an introductory workshop on cerebral palsy, also known as
information enrichment workshop (IEW). IEW was filled in with three distinctive lectures
and hands-on activity by a pediatric neurologist, physiotherapist, and occupational
therapist. Each session lasted approximately for 40 minutes to one hour with 15 minutes
break in between sessions. The value of having this workshop also acts as an ice-breaking
session and promotes rapport between the caregivers and the experts in managing CP
children. The second activity was held one month apart from the workshop whereby a
forum session was held. The researcher team acted as the moderator and three panels
were invited of which one of them was a representative from Department of Social
Welfare (DSW), as the official government body in welfare provision, another panel was
a representative from Kelantan Foundation For The Disabled as a charitable non-
governmental organization and the third panel was from Special Education Unit, Kelantan
Education Department to discuss on issues related to the welfare of CP children and their
caregivers including training programs and job opportunities as well as special education
for CP children. Subsequent from the previous two activities, the engagement of
information support through CP Support program was continued with series of
caregiver’s support group (CSG) gatherings. To fulfill their unmet needs for information,
the caregivers were given opportunity to freely choose their own topics of interest to be
discussed in the next CSG gathering. The chosen topics include neurorehabilitation,
wheelchair assessment and modification, stress management, importance of oral hygiene,
good diet practice for CP children and support for children who require hospital
admission. The topics were delivered by neurorehabilitation specialist, wheelchair team
coordinator, psychologist, dentist, dietitian, and officer from medical welfare unit
respectively. The support from professionals in multidisciplinary teams and other
caregivers was continuously provided through a WhatsApp group. The platform is
continuously used to update the caregivers on latest program related to CP, for caregivers
to express their concern on matters related to their CP children, provide a channel of
communication among caregivers themselves, provide a channel for the caregivers to
seek expert opinion when in doubt. It reduces gap between caregivers and health experts
and sustains the information and social support among caregivers. The intervention
package was delivered as a monthly program to the intervention group caregivers in view
of logistic problem and to avoid overlapping of program organized by the DSW since our
intervention was held at the DSW facility. After completing the post-intervention data
collection, caregivers in the control group also received the intervention package for
ethical reasons.
3.3. Statistical analysis
Factorial ANCOVA was performed to determine the effect of the intervention. A p-value of
less than 0.05 was considered statistically signiﬁcant.
4. Results
The total number of subjects in the study was 66, of whom 21 were caregivers in the
intervention group and 45 were enrolled in a control group. All of them were Malays and
majority of them were females (90.9%) where half of them were housewives of which
they were categorized under unemployed. The mean age (SD) of the caregivers was 44.23
6
years old (10.48) and mean (SD) duration of caregiving was 14.33 (8.02) years. Most of
the caregivers were married (83.3%). All our respondents were registered with the
Department of Social Welfare (DSW), sixty of them received monthly financial support
from the DSW. When income was categorized based on B40 cut-off point most of the
caregivers had household income of RM 3860 and less (92.4%). Education level,level of
perceived stress and FNS score were the variables that had significant difference between
intervention and control groups at baseline (p = 0.026, p<0.001 and p<0.001 respectively)
(Table 1).
Table 1: Caregivers’ characteristics of control and intervention groups
n (%)
Variables Overall Control Intervention p value
(n = 66) (n = 45) (n = 21)
Age (years) 44.2(10.84† 44.7(11.45) † 43.3(9.61† 0.633*
Gender
Male 6 (9.1) 3 (6.7) 3 (14.3) 0.373**
Female 60 (90.9) 42 (93.3) 18 (85.7)
Education level
No formal education/ 14 (21.2) 13 (28.9) 1(4.8)
Primary education 0.026***
Secondary/Diploma/Degree/ 52 (78.8) 32 (71.1) 20 (95.2)
Postgraduate
Employment status
Unemployed 37 (56.1) 25 (55.6) 12 (57.1) 0.904***
Employed 29 (43.9) 20 (44.4) 9(42.9)
Income
RM 3860 and less 61 (92.4) 43 (95.6) 18 (85.7) 0.386**
More than RM 3860 5 (7.6) 2 (4.4) 3 (14.3)
Number of children
Less than 4 28 (42.4) 17 (37.8) 11 (52.4) 0.246***
4 and more 38 (57.6) 28 (62.2) 10 (47.6)
Training experience
Yes 14(21.2) 8 (17.8) 6 (28.6) 0.318***
No 52 (78.8) 37 (82.2) 15 (71.4)
Comorbidities
Yes 29 (43.9) 21(46.7) 8 (38.1) 0.513***
No 37 (56.1) 24 (53.3) 13 (61.9)
Duration of caregiving 14.33 (8.02) 14.80 (8.31) 13.24 (7.30) 0.463*
(years)
Level of stress 15.02 (5.98) 13.53 (6.30) 18.19 (3.67) <0.001*
FNS score 19.11 (7.21) 26.95 (7.61) <0.001*

† Mean (SD) *Independent t-test **Fisher’s exact test ***Chi-square test SD, standard deviation
The mean age (SD) of CP children was 15.27 (7.76) years old. Most of the caregivers
(71.2%) indicated that the diagnosis of CP was made when their children were less than
one year old. Male CP children were more dominant in number than female CP children.
Fifty-nine of these children actively involved in CBR program or kindergarten, one child
was in primary school and two CP children were in secondary school. Most of the
caregivers in our study had children with severe CP according to Gross Motor Function
Classiﬁcation System (GMFCS) by Palisano et al. (1997). There was no significant
7
difference in the children’s sociodemographic characteristics between control and

intervention groups (Table 2).
Table 2: Cerebral palsy children’s sociodemographic characteristics of control and

intervention groups
n (%)
Variables Overall Control Intervention p value
(n = 66) (n = 45) (n = 21)
Age of CP child (years) 15.3 (7.76† 16.4(7.86† 13.0(7.18† 0.097*
Gender of CP child
Male 42 (63.6) 30 (66.7) 12 (57.1)
Female 24 (39.4) 15 (33.3) 9 (42.9) 0.454**
GMFCS
I, II, III 9 (13.6) 5 (11.1) 4 (19.0) 0.382**
IV, V 57 (86.4) 40 (88.9) 17 (81.0)
Presence of other
caretakers 0.665**
Yes 32 (48.5) 21 (46.7) 11 (52.4)
No 34 (51.5) 24 (53.3) 10 (47.6)
† Mean (SD) *Independent t-test **Chi-square test, SD, standard deviation
At baseline, there was no significant difference in pre-MSPSS score (p=0.917) (Table 3).
Table 3: Comparison of baseline (pre-intervention) MSPSS scores between Control and

Intervention Groups
Variables Control Intervention Mean t- statistics p value *

(n= 45) (n = 21) difference (df)
mean (SD) mean (SD) (95% CI)
Pre-MSPSS 5.02 (0.92) 5.05 (1.14) -0.03 0.10 (64) 0.917

(-0.55, 0.50)
*Independent t-test; SD, standard deviation; CI, confidence interval; df, degree of freedom
There was no significant mean score differences observed between pre and post
intervention in both groups (Table 4).
Table 4: Comparison of MSPSS scores within groups
Variable Groups Pre- Post- Mean t- p value*

interventio interventio difference statistic
n n (95% CI) s
Mean (SD) Mean (SD) (df)
MSPSS Control 5.02 5.11 -0.08 -0.63 0.534
(0.92) (0.68) (-0.34, 0.18) (44)
Intervention 4.97 5.28 -0.21 -0.98 0.338
(1.07) (0.71) (-0.67, 0.24) (20)
*Paired t-test CI, confidence interval; df, degree of freedom
Post MSPSS score was higher in the intervention group compared to control group, but
the differences between these study groups was not statistically significant (p = 0.392)
(Table 5).
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Table 5: Comparison of post-MSPSS score between intervention and control groups
Mean Mean difference t- statistics p

(SD) (95% CI) (df) value*
Group
Control 45 5.11 (0.71) -0.16 0.62 0.392
Intervention 21 5.27 (0.69) (-0.53, 0.21) (1,64)
*One-way ANOVA CI, confidence interval; df, degree of freedom
When the possible confounding variables such as pre-MSPSS score, caregivers’ education
level, age and level of perceived stress, gender of CP children, number of CP children,
duration of caregiving, number of children, income, and severity of CP according to GMFCS
were adjusted, the post MSPSS score was significantly different between the two groups
(p= 0.031) (Table 6).
Table 6: Comparison of post MSPSS scores between the two study groups after
controlling for potential confounders
Adjusted Mean Adjusted F statistics p

(95% CI) Mean (df) value
difference†
(95% CI) ‡
Group
Control 45 5.03 (4.67, 5.39) 0.42 4.88 (1, 54) 0.031
Intervention 21 5.45 (5.03, 5.89) (0.04, 0.81)
†Adjusted mean using factorial ANCOVA after controlling for pre-MSPSS score, FNS score, caregivers’
education level, caregivers’ age, caregivers’ level of stress, gender of CP children, number of CP children,
duration of caregiving, number of children, income, and severity of CP according to GMFCS ‡Bonferroni
adjustment for 95%
CI for difference. R squared = 0.566 CI, confidence interval; df, degree of freedom
For each MPSS domain, intervention effect was found to be significant for post-Significant
Others (Table 7).
Table 7: Comparison of post MSPSS domain scores (each domain) between the two
study groups after controlling for potential confounders
Domain Groups n Adjusted Adjusted F p value

Mean (95% Mean statistics
CI) difference† (df)
(95% CI) ‡
Post Family Control 45 5.43 0.38 1.98 0.165
(4.95, 5.90) (-0.16,0.92) (1.53)
Intervention 21 5.80
(5.19, 6.41)
Post-Friend Control 45 4.70 0.32 1.25 0.269
(4.20, 5.20) (-0.26,0.90) (1.53)
(4.36, 5.68)
Post Control 45 5.13 0.61 5.42 0.024
Significant (4.66, 5.59) (0.09,1.14) (1.53)
Others
9
(5.14, 6.34)
†Adjusted mean using factorial ANCOVA after controlling for Pre MSPSS score, FNS score, caregivers’
education level, caregivers’ age, caregivers’ level of stress, gender of CP children, number of CP children,
duration of caregiving, number of children, income, and severity of CP according to GMFCS ‡Bonferroni
adjustment for 95% CI for difference
CI, confidence interval; df, degree of freedom
5. Discussions
Our study shows the baseline MSPSS score was not significant, suggestive of comparable
groups of caregivers of children with CP. Despite both groups showed an increment of
MSPSS score within the study period, greater improvement is seen in MSPSS score among
the intervention group caregivers suggestive of our intervention had merits on improving
social support. This finding was further strengthened when the potential confounders
were controlled. One possible explanation for the significant intervention effect could be
attributed by the characteristics of caregivers in the intervention group who were more
stressful compared to the control group. The intervention might be seen as a resolution
to overcome their problems as they appreciate this programme much better in the time
they need most. As other study suggests that a measure of support received when needed
would predict greater perceived support (Melrose, Brown, & Wood, 2015).
Result from the present study found that in general, both groups showed an improvement
in social support from family, friends and significant others except for the control group
who perceived less support from the significant others. Further examination on each
domain of MSPSS revealed that, significant others might contribute to the overall MSPSS
intervention effect as shown by the significant intervention effect only on this domain.
Although this present study did not explore further on who were the significant others
meant to the caregivers, previous local study done among mothers of children with CP
mentioned that the value of spouse as the significant others was essential in providing the
most of social support (En & Juhari, 2017). In view of majority of participants in our study
were married women, it is possible that they associated spousal support as the source of
social support from significant others. Very commonly that caregivers of chronic illness
seek help from family members. Since both groups had an increased score in social
support from family, we can postulate that spouses are a likely source of social support,
in view of most of our caregivers were married mothers. Given the nature of many
stressors that they are more likely to be experiencing together, spousal support is crucial
in alleviating the burden of caregiving and improving the health outcomes in the main
caregivers (Dehle, Larsen, & Landers, 2001). Previous study had demonstrated that
support provided by a spouse may take precedence over other sources of support (Siklos
& Kerns, 2006) especially in times of crises when the spouse is often the first person
sought for support (Dehle et al., 2001). Though spousal support seems to be superior to
other types of support, it is also possible that the caregivers in our study also receive
support from other family members. Having said that, on average, the caregivers in our
study had five household members living together with a possibility as an extended
family. Extended family refers as any persistent kinship grouping of persons related by
descent, marriage or adoption, which is wider than the nuclear family, comprising at least
three generations, from grandparents (one or both) to grandchildren (Embong, 2002)
which is still common in Kelantan. In the absence of spousal support as in a frail marital
relationship, the mother, as the child’s major caregiver, tend to seek support in her closest
relational system, especially her other children and other women in the family, such as
grandmothers and aunts (Lee & Gardner, 2010).
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The significant intervention effect may also be explained by the social support provided
by other caregivers throughout the discussion either physically or via the WhatsApp
group. Social support is more effective when it comes from those who are socially similar
in values and characteristics, and who are facing or have faced similar stressors somewhat
more successfully (Heaney & Israel, 2008).
Through provision of informational support from the CP Support intervention, blended

with the involvement of multidisciplinary team, the caregivers built sense of belonging
within the group and increased the size of social network (Boyd, 2002). Evidence from
previous interventional study in providing informational supports had shown that
participation in professional led group among other parents with children of similar
condition increased perception of peer and professional support, boosted their
confidence in understanding their child’s condition and increased their capacity in
decision making (McAleese, Lavery, & Dyer, 2014; Tolmie, Bruck, & Kerslake, 2017). The
presence of WhatsApp group ensures the sustainability of the informational support by
the professionals. Caregivers may utilize the WhatsApp group to clarify any doubts
regarding problems faced by their CP children which may narrow the gap between
professionals and parents. The WhatsApp group is also a platform for the professionals to
share any announcement or relevant information to the caregivers.
Nevertheless, the findings should be interpreted with caution due to several limitations.
Randomization was not possible in this study in view of limited sample that was available
and logistic problems. Subsequent to having heterogenous groups, presence of
extraneous variables is possible that potentially confound the effect of study variables.
Characteristics of the intervention group differed somewhat to those caregivers in the
control group most notably in terms of education level and perceived stress. However, the
effect of these confounders was controlled in the multivariable analysis.
6. Conclusion
Findings of this study highlighted the favorable outcome of the CP Support intervention
program on the caregivers’ perceived social support through provision of information and
social support. It justifies the need of implementing family centered care (FCC) in a
multidisciplinary approach to improve the caregivers’ perceived social support, thus
improving the quality of care to the CP children.
Acknowledgement
We would like to express our gratitude to all participants, USM Cerebral Palsy Research
Cluster (CPRC) secretariats, CPRC teams and USM for providing fund via RU Top Down
1001.CSKK.870020 grant and those who directly or indirectly involved in the study.
Funding
USM RU Top Down 1001.CSKK.870020 grant.
Conflict of Interests
The authors declare no conflict of interest in this study.
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Malaysian Journal of Social Sciences and Humanities (MJSSH) (e-ISSN : 2504-8562)

2022, Volume 7, Issue 4, e001419

The Effectiveness of Cerebral Palsy Support Intervention on

Siti Aisyah Zakaria1 , Azriani Ab Rahman2* , Mohd Ismail Ibrahim3,

Kubang Kerian, Kelantan, Malaysia.

Kubang Kerian, Kelantan, Malaysia.

on the caregivers’ perceived social support through

Contribution/Originality: This study contributes to the existing literature on the

This study aimed to determine the impact of CP support intervention on caregivers

Despite the current support delivered by the governmental and non-governmental

To our knowledge, there is no local study specifically looking at the effectiveness of CP

A quasi-experimental study was conducted among caregivers whose children were

Multidimensional Scale of Perceived Social Support (MSPSS-M) is a self-administered

3.2. CP Support intervention program

The provision of informational support was delivered through an intervention program,

3.3. Statistical analysis

Table 1: Caregivers’ characteristics of control and intervention groups

FNS score 19.11 (7.21) 26.95 (7.61) <0.001*

difference in the children’s sociodemographic characteristics between control and

Table 2: Cerebral palsy children’s sociodemographic characteristics of control and

Table 3: Comparison of baseline (pre-intervention) MSPSS scores between Control and

Variables Control Intervention Mean t- statistics p value *

Pre-MSPSS 5.02 (0.92) 5.05 (1.14) -0.03 0.10 (64) 0.917

Table 4: Comparison of MSPSS scores within groups

Variable Groups Pre- Post- Mean t- p value*

Table 5: Comparison of post-MSPSS score between intervention and control groups

Mean Mean difference t- statistics p

Adjusted Mean Adjusted F statistics p

Domain Groups n Adjusted Adjusted F p value

Through provision of informational support from the CP Support intervention, blended

USM RU Top Down 1001.CSKK.870020 grant.

The authors declare no conflict of interest in this study.

of medical students in Faculty of Medicine, University Malaya. Asian Journal of

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