Participatory capacity development Report of a community based training needs assessment in Vietnam

World Federation of Occupational Therapists Bulletin

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Participatory capacity development: Report of a
community-based training needs assessment in
Vietnam

Angelique Cornelia Maria Kester & Vera Cinzia Kaelin

To cite this article: Angelique Cornelia Maria Kester & Vera Cinzia Kaelin (2020): Participatory
capacity development: Report of a community-based training needs assessment in Vietnam, World
Federation of Occupational Therapists Bulletin, DOI: 10.1080/14473828.2020.1817654
To link to this article: https://doi.org/10.1080/14473828.2020.1817654

Published online: 17 Sep 2020.
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WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN
https://doi.org/10.1080/14473828.2020.1817654

Participatory capacity development: Report of a community-based training
needs assessment in Vietnam

Angelique Cornelia Maria Kestera,b and Vera Cinzia Kaelin c

aSenior Advisor Childhood Disability, Enablement, Liliane Foundation, Alphen aan den Rijn, Netherlands; bTheme Advisor Rehabilitation and
CBR, Liliane Foundation, Hertogenbosch, Netherlands; cDepartment of Rehabilitation Sciences, University of Illinois at Chicago, Chicago, IL,
USA

ABSTRACT KEYWORDS
Caregiver; community health
Training needs assessments can lead to participatory capacity development. However, few worker; disability;
participation; occupational
reports exist on this from an occupational therapy perspective. The purpose of this paper is therapy

to recount the experience and process of a training needs assessment in a mountain area of

Vietnam. We visited 10 families and their children with disabilities and interviewed three

local project partners to gain insight into their needs for supporting the participation of
children with disabilities in daily activities. Four themes were identified through the needs
assessment: ‘Getting to know the context’, ‘The life and biggest worries of families with
children with disabilities’, ‘Support of children with disabilities and their families’, ‘Wishes and
needs for future training’. The outcomes revealed specific needs for improving participation
and functioning in activities of daily life from different perspectives. It showed how the
needs fit the concepts of occupational therapy as a client-centred profession focusing on
participation in daily life.

Children with disabilities are one of the most vulner- 2018). In Vietnam, the first 36 bachelor’s degree occu-
able groups in Vietnam and represent nearly 2.79% pational therapists graduated in August 2019 (Vietnam
of the Vietnamese population aged between 2 and 17 Times, 2019).
years (UNICEF, 2018; Global Disability Rights Now,
n.d.). Of those children, more than one fourth live in The Butterfly Basket Foundation (BBF) is a Dutch
poverty (UNICEF, 2018), which is highly prevalent in Non-Governmental-Organization (NGO) consisting
rural and mountain areas in Vietnam and represents of four occupational therapists, one physical therapist
a major risk for participation restrictions among chil- and one speech/language therapist. Together with
dren with disabilities (Duncan, 2009; UNICEF, 2018). local partners in Vietnam, including NGOs, the physical
In mountain areas, child and maternal mortality rate therapy faculty and one of the two occupational therapy
is four times higher compared to urban areas (UNI- faculties in Vietnam (i.e. at the University of Medicine
CEF, 2020); and healthcare is less accessible and pro- and Pharmacy in Ho Chi Minh city; the other faculty
vided with less qualified staff (UNFPA, 2011; is at Hai Phuong Medical Technical University), we
UNICEF, 2018). Besides, only 1 out of 8 health care have been working in Vietnam for over 10 years, closely
staff is trained in rehabilitation services (UNFPA, collaborating with service providers and families of chil-
2011), not including occupational therapy. Despite dren with disabilities. Each year, a team, mainly consist-
Vietnam ratifying the Convention on the rights of per- ing of occupational therapists, travels to Vietnam to
sons with disabilities in 2015, people with disabilities provide training focusing on knowledge and skills to
continue to face major inequalities to participate in support families and their children with disabilities in
daily activities (Bogenschutz et al., 2020). participating and performing daily activities. We follow
the principles of capacity development in community
Occupational therapy plays an important role in settings, as recommended by Rosenthal (2009).
supporting persons with disabilities in their partici-
pation and performance of daily activities (WFOT, Capacity development for community-based ser-
2017). In countries such as Vietnam, where occu- vices can be described as developing knowledge and
pational therapy is emerging, international collabor- tools that help communities identify, explore and
ation of occupational therapists and other service work on issues that are important to them and their
providers is a way to support participation and activity situation (Liberato et al., 2011). Capacity development
performance of children with disabilities as well as the has also been defined as one of the research priorities
development of occupational therapy (Dsouza et al., by the World Federation of Occupational Therapy
(Mackenzie et al., 2017). This current paper contributes

CONTACT Angelique Cornelia Maria Kester [email protected]; [email protected] Senior Advisor Childhood Disability, Enablement, Liliane
Foundation, Antonie van Leeuwenhoekweg 38 A16, 2408 AN, Alphen aan den Rijn, Netherlands www.linkedin.com/in/angeliqueester7a410

© World Federation of Occupational Therapists 2020

2 A. C. M. KESTER AND V. C. KAELIN

to a central aspect of capacity development by taking a Table 1. Characteristics of families, children with disabilities,
collaborative approach in defining training needs. Even staff.
though this paper does not represent research, it is
important for occupational therapists to have these pri- Child’s Reported child’s
orities in mind when engaging in projects relevant to gender
occupational therapy. Respondents Child’s age diagnose

Often, we receive requests for training from local Mother Girl 8 Intellectual
partners to increase capacity for knowledge, attitude disability
and practice in the field of rehabilitation. We strongly Father, Mother, Boy
believe that, before providing any support such as in Grandmother 9 Cerebral Palsy
forms of training, it is crucial to first explore stake- Girl
holders’ needs and desired capacity, to ensure fit. Father Girl 2 Cerebral Palsy
This is in line with capacity development and evidence Mother, Father 11 Intellectual
highlighting the importance of collaborating with
community partners to tailor supports to their needs Child, Mother, Father, Boy disability
and to foster reciprocal learning and shared decision Grandmother 8 Cerebral Palsy
making (Brown, 2002; Magnusson et al., 2019; Boy
Suarez-Balcazar et al., 2015; Witchger Hansen, Grandmother Boy 8 Cerebral Palsy
2015). This includes conducting a needs assessment, Grandfather 6 Intellectual
which has also been described as an essential first
step when providing training (Brown, 2002) and a Father, Grandfather, Boy disability
promising way to support development of the field Sister 7 Cerebral Palsy
of rehabilitation in low- and middle-income countries Girl
(Magnusson et al., 2019). However, few reports exist Child, Father Girl 10 Cerebral Palsy
on training needs assessments with an occupational Mother, Father Gender 6 Cerebral Palsy
therapy focus in low- and middle-income countries. Respondents Female Professional background
The purpose of this paper is, therefore, to recount out- MACDI project officer Female Finances
comes and the process of conducting a training needs MACDI community Finances
assessment in a rural mountain area of Vietnam for Female
capacity-building of the community to address activity health worker Administration
performance and participation needs of children with RCI project officer
disabilities.
Note. MACDI = Micro-finance and Community Development Institute; RCI
The project = Research Center for Inclusion.

The Netherland’s Leprosy Relief Mekong Office, now Table 1). The families were selected by MACDI com-
known as Research Center for Inclusion (RCI), is a munity health workers and were of Mường ethnicity
Vietnamese NGO that specialises in projects on (Mundi Index, 2018). Families included parents as
inclusion of people with disabilities. They are one of well as grandparents, as living with multiple gener-
our strategic partner organisations in Vietnam and ations is common in Vietnam (Mestechkina et al.,
work with smaller local organisations such as the 2014). MACDI community health workers have a
Micro-finance and Community Development Institute background in finance, perform micro-credit activities
(MACDI) Vietnam. RCI approached us with a request for MACDI, visit families regularly, and are familiar
to provide a training for caregivers and community with the community.
health workers as part of a pilot project in HoaBinh
province. This project focused on supporting partici- Collecting the perspectives of involved
pation of children with disabilities in their community stakeholders
by directly assisting them, improving their health and
functioning, creating an enabling environment, and Our training needs assessment was based on the first
supporting the families financially. phase of the training cycle by Hasselqvist and Thomas
(2012; see Figure 1). This first phase includes a seven-
Involved stakeholders step process to identify problems, key stakeholders,
current and desired capacities of stakeholders, the
In this project we worked with 10 families and their decision whether training can contribute, and if so,
children with disabilities as well as three local staff specify training design and content (see Figure 2).
members in Hoa Binh province, Tan Lac district (see
The participatory manner of this training needs
assessment (Hasselqvist & Thomas, 2012) aligns with
the philosophy of the BBF and is emphasised in other
community-based training and intervention
approaches such as ‘Getting to know Cerebral Palsy’
(London School of Hygiene & Tropical Medicine, n.d.;
WHO, 2010; Zuurmond et al., 2018) as well as the
WHO rehabilitation guidelines (WHO, 2010).

To ensure fit with the culture and environment in
the targeted community as well as alignment with the
pilot project, we prepared the training needs assess-
ment in collaboration with our project partners, RCI
and MACDI. The seven steps (see Figure 2) were inte-
grated into a semi-structured interview guide with
questions about stakeholder’s current and desired

WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 3

Figure 1. Training cycle from Hasselqvist& Thomas. Reprinted with permission from ‘Manual, Training Needs Assessment and Train-
ing Outcome Evaluation’, by Hasselqvist & Thomas, 2012, p. 9. Copyright 2012 by United Nations Human Settlements Programme.

knowledge, attitude and practice around children’s Community health worker
participation and activity performance. We went dee-
per into each aspect by asking about their current situ- . What are the things you like or find most difficult
ation, strengths and challenges, needs, and ideas during a visit to a family?
(Dexter et al., 2009; Trinh, 2011). Examples of inter-
view questions were as follows: . What additional knowledge would you need to sup-
port your families and their child’s participation and
performance of daily life activities?

Child Caregiver

. What are the things that are most difficult during a . What do you do when you have questions or need
normal day? help about your child’s abilities and participation
in daily life activities?
. What is your biggest wish for your time at school,
the community and home?

Figure 2. The Training Needs Assessment Process from Hasselqvist& Thomas. Reprinted with permission from ‘Manual, Training
Needs Assessment and Training Outcome Evaluation’, by Hasselqvist & Thomas, 2012, p. 15. Copyright 2012 by United Nations
Human Settlements Programme.

4 A. C. M. KESTER AND V. C. KAELIN

. If there was a training for caregivers about children Our project followed the principles of the Declara-
with disabilities, what should be in there that fits tion of Helsinki (World Medical Association, 2013)
your needs? and was designed as a systematic investigation to
gain knowledge. It involved interaction with people
Between September 2016 and June 2017, two occu- for the purpose of collecting their personal reflections
pational therapists of BBF (authors of this study) vis- and experiences.
ited 10 families together with experienced staff
members of MACDI that served as language Project outcomes
interpreters fluent in Vietnamese and English. After
receiving written informed consent, we conducted Following the steps of the training needs assessment,
interviews with families, a community health worker, we (i.e. occupational therapists and involved stake-
and MACDI- and RCI project officers, each lasting holders) collaboratively concluded fit for training
between two to three hours. When children could based on the four following themes that emerged
express their thoughts, they were involved in the con- from participants’ responses: ‘Getting to know the con-
versation. For conducting the interviews, one occu- text’, ‘The life and biggest worries of families with chil-
pational therapist led the discussion with the family dren with disabilities’, ‘Support of children with
while the other took notes. Their roles alternated disabilities and their families’, ‘Wishes and needs for
between interviews. The interviews were recorded as future training’.
an addition to the notes. Notes contained a detailed
description of the conversation and unstructured Getting to know the context
observations of the environment. Additionally, features
of the physical environment were captured via photos. The visits at the houses of families allowed us a better
insight into the way of living in this region of Vietnam,
Analysing interviews and its associated challenges. One example of the
impact of the local context was the steep stairs used
The interview notes were extended using the record- to enter the houses built on stilts, common in this
ings and were checked by MACDI and RCI project region. Caregivers mentioned the resulting dependence
officers to ensure accuracy. To analyse the interviews, of children and the exertion of carrying the children up
both authors went line by line through the extended and down the stairs, which was especially the case
interview notes. Mind mapping was used to visualise when caregivers were the grandparents.
the process and to identify patterns that led to themes.
Next, the authors had regular discussions, while going Throughout our visits, we saw very few assistive
back and forth between the themes, notes, photos and devices to support these children in their daily lives.
previous experiences in Vietnam. We placed our We learned that families that had assistive devices were
interpretations within the context of the children, inspired by what they had seen on television, using
caregivers and MACDI community health workers local resources such as wood and bamboo. One family,
in Vietnam, using an occupational therapy perspec- for example, attached two horizontally positioned paral-
tive. The outcomes were written up in a report and lel bars from bamboo sticks to the house’s structure so
checked and approved by the project officers of that their boy with a physical disability could practice
MACDI and RCI. Checking with the community walking. Despite having few advanced assistive devices,
health worker was not possible due to time we observed that most families had many pillows and
constraints. blankets in their houses. We learned that this is a com-
mon wedding gift for this ethnic group. Pillows and

WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 5

blankets can be helpful for positioning children with dis- know how to [get in] contact with [a] person who
abilities in their home and was therefore valuable infor- has knowledge about the [child’s] disability for advice.
mation for possible future training. I know his situation, it’s hard to improve in the future.
We try to do [our] best for him and hope for a little bit
Besides getting to know the physical environment, more improvement. We first participated in a screen-
we learned about the structural challenges that com- ing. After treatment in the hospital, nobody came
munity health workers experience. They are expected here. They just advised me to improve the boy by
to cover many different topics during home visits, ran- movement method. (father)
ging from nutrition to housing. Despite challenges and
time constraints, community health workers that we The feeling of having very limited knowledge about
spoke with were incredibly committed to helping the the diagnosis of their child, the prognosis and the way
families, as one worker described: of supporting the child in ADLs was mentioned fre-
quently, as one father stated:
I visit a lot of families [with children with disabilities],
I think all families [have a] very difficult situation, so The doctor said, ‘no hope’. […] He said it will be
they need a lot of support from [the] community difficult to take care of her. She will not become
and [the] community needs to sympathize with [the] older than 20 years. He didn’t explain much, just
families. I never have a negative attitude [myself]. In that it will be difficult to raise her, but not much
[this commune] we have a lot of children with disabil- more. We would like to know what is CP and how
ities and when I visit some [of them], I feel very sad is it in the future so that we can support her better.
and almost cry.
Most information caregivers received related to
Some community health workers, caregivers and body functions and structures. No information was
MACDI staff attended a previous training course provided on what to expect and how to support at
between mid-2015 and mid-2016 from doctors of the the activity and participation levels, or the consider-
provincial hospital, which was their first access to ation of environmental and personal factors. A grand-
knowledge about children with disabilities. They mother described her experience and how the given
mostly remembered learning specific exercises to do information affected the choice the parents of the
with the children, such as stretch and massage the child made:
arms and legs, which they then taught to families.
When he was born, he [was] very weak, and we
The biggest worries of the families [thought] he [would] die and after that we [brought]
him to Hanoi and treatment there, two days after he
All the families we visited discussed the difficulties they was born. The doctor couldn’t do anything and after
experienced related to their child’s performance of that he [was] like that [points to boy lying on the
activities of daily life (ADLs), such as eating, bathing bed]. When we [took] him to the hospital [and] the
and toileting. The children we spoke to not only doctor said that they cannot [provide] treatment
expressed the wish to be better at doing activities […] and he would become disabled, so we stopped
such as brushing the hair and playing with a doll, but treatment and [his] parents then divorced and his
also to increase their social participation. A girl mother [brought] him from his house to give to me
described wanting to play soccer with her brother, and mother goes to Hanoi to work and get married
while a boy described his challenges in participating there.
at school: ‘I wish I could join my classmates to play’.
He described having friends but was unhappy because The service providers also expressed a lack of infor-
they never came over to his house, whereas he could mation and knowledge about children’s disabilities and
not walk to their house. coaching approaches to support the families and the
children in participating in ADLs. The support that
Caregiver and staff responses were often related to service providers offered mostly pertained to providing
how to support their child in managing ADLs and emotional support to the family or bringing them some
often yielded responses related to caregiver assistance. candy and food. Although the emotional support was
One father explained: highly appreciated by the families, families expressed
the need for more knowledge and support in ADLs.
We don’t know how to take care of her, any methods
or better interventions to use? We don’t know what is For caregivers, supporting their child with a disabil-
the good way and want to know. Any course, we want ity to perform ADLs resulted in less time for work, less
to participate. earning of important money for the family, and
reduced contributions to the community such as the
Within these worries and questions, a great need for required choirs in the village, which are common
knowledge to best support their child emerged: duties in rural areas of Vietnam. A mother described
her difficulties in simultaneously supporting her child
[In] remote area [it is] so difficult to access infor- and fulfilling expectations for work:
mation, [I] don’t know where to get this. Don’t
She cannot manage her pee and poo. It’s very hard for
me because I have to clean the house, wash her, cook

6 A. C. M. KESTER AND V. C. KAELIN

for her and feed her and then I can go to work. Wishes and needs for future training
Because all people around me go to work earlier.
Caregivers wished to learn about suitable assistive
Going to work, especially if no other family mem- devices and receive advice as to how to support their
bers could support, often meant leaving the child child to participate in ADLs such as washing, toileting,
home alone. One community health worker described: managing female hygiene, walking, or eating by him-
or herself. Additionally, they hoped for support to
Besides[the] difficulty to look after [a] child with [a] reduce the strain of these activities for caregivers. A
disability they have got problem with economic. All father described it as follows:
families that have a child with [a] disability here are
poor so they have to work a lot and don’t have a lot I wish to learn to take care of her – daily activities.
of time to look after their children. [I] always see the How serious CP is. [Is there] Any hope and improve-
parents of children with disabilities go out to work ment in the future? I wish I would have more money
and let the children stay at home. Then grandparents to take her to the hospital. I wish to take her to a facil-
sometimes take care of them. ity because I don’t know how to take care of her.

When leaving the child at home, some caregivers were Service providers wanted to learn to coach care-
concerned for the child’s safety and that they might injure givers and children with disabilities to participate in
themselves. In case of girls, caregivers also worried about ADLs. All stakeholders shared detailed ideas about
the risk of sexual abuse towards their child. Another fac- how a training course could be structured to promote
tor that increased pressure for caregivers was children’s sustainable knowledge translation and to fit the local
incontinence while the caregivers were at work and context. Trainings should include much repetition,
away from the home, meaning the child and house videos, practicing with the children directly and
would need to be cleaned upon every return. recording this practice, sharing experiences with each
other, and involving stories of potential, preferably in
Caregivers seemed very hesitant in asking support small groups.
from neighbours and did not want to put burden on
other people. They were also concerned with who I would teach them [caregivers] how to manage daily
would care for their child if they would pass away. activities. Integrate video and work directly [in train-
Of further concerns were attitudes of some neigh- ing] with the children. Encourage them that the chil-
bours, teachers, or other community members. One dren can do things – [tell and show them] stories of
father described the negative remarks made by neigh- potential. (community health worker)
bours who blamed the family for having a child with a
disability because of the grandfather fighting in the We discussed and jointly concluded that caregivers,
war and because of the use of pesticide on their health community workers and the families would
field, in which chemical exposure might have caused benefit from future training. In this context, we also
the disability. learned that both caregivers and health community
workers prefer and suggest active games, exercises
Support of children with disabilities and their and competitive elements within training. Besides the
families structural aspects of training, we learned that visual
information may be more accessible to some elderly
In addition to the support families of children with caregivers who have difficulty reading and writing.
disabilities receive from MACDI staff and commu- Additionally, we learned what seasons would be best
nity health workers, we learned about the value suited to schedule a training. Wet seasons, for example,
families placed on having contact with families in would lead to many difficulties for participants travel-
similar situations. Some families also received sup- ling over unpaved roads by motorbike with their
port from close relatives who were helping the children:
child to participate in the home, community, or on
the field for example for harvesting crop as this Not [a] good time [for training] would be harvest sea-
father describes: son or winter. The training should take place in the
commune building for [a] maximum of three days.
Family and neighbors understand and [are] suppor- […] The mother should attend because she is closer
tive, the spirit, encouragement, share, understand, [to the child] and looks after the child. Beside the chil-
talk. We have contact with other families [with a dren and parents, we should invite community health
child with a disability]. This is supportive. We can workers and MACDI staff, because if they learn, they
share with each other, together. can help [the parents] again also. We should also
invite relatives of children with disabilities because
Two of the visited families were in contact with in case that parents are busy, their relatives can help.
other families that had a child with a disability. The (community health worker)
other families expressed a great wish for this peer sup-
port to share their stories. Caregivers wished to bring their child to the train-
ings for practical, safety and learning purposes.
Additionally, we also learned that it would not be

WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 7

possible, especially for single parents, to participate in concurrently manage work and their child’s care. Difficul-
trainings lasting longer than one day as they cannot ties in supporting children’s performance in ADLs have
stay away from work for that long. been described as a major concern of caregivers in previous
research conducted in Vietnam, capturing reflections of
To summarise, the following training content and Vietnamese caregivers of children with disabilities on
methods were suggested by the stakeholders and will ADL (Kester et al., 2018). Also, the described challenge
be addressed in future training for this community. of taking care of a child with a disability while also mana-
ging work is consistent with previous research in Vietnam
Desired training content: reporting higher parental stress in families of lower econ-
omic status (Shin et al., 2006). Negative attitudes towards
. Knowledge to help understand the diagnosis and families of children with disabilities were experienced by
capabilities of the child, now and in the future. all caregivers we met and are common in Vietnam (Dexter
et al., 2009) as well as other low- and middle-income
. Skills and knowledge on how to take care of the countries (e.g. Binh et al., 2017; Bunning et al., 2020; Kiling
child in managing ADLs such as washing, handling et al., 2019; Nyante & Carpenter, 2019). These attitudes are
hygiene, moving around the house or eating. often shaped by a belief of being punished for sin of family
members in current or previous lifetime (Burr, 2015; Insti-
. Skills and knowledge on how to protect the child tute for Social Development Studies, 2013; Ritter et al.,
from verbal, physical and sexual abuse. 2019). They often led to withdrawal of families from the
community or hiding the condition of the child (Ngo
. Learning from the situation of other caregivers by et al., 2012).
sharing stories.
To address challenges in children’s activity perform-
. Skills and knowledge to coach families in supporting ance and participation Salomone et al. (2019) suggested
their child in ADLs. to include family-centred goal setting and the use of
environmental strategies in caregiver trainings in
. Learn how to support children in doing some activi- middle- and low-income countries. Both of those
ties by themselves or how to make the activities less aspects are core concepts of occupational therapy prac-
of a strain for caregivers. tice and have been shown to be effective to support
children’s participation (Anaby et al., 2016). Similarly,
Desired training methods: limiting stigma and discrimination against people with
disabilities to participate in daily life is a main focus in
. Combined, short training sequences for caregivers occupational therapy (WFOT, 2020). To influence
and fieldworkers. societal attitudes at a local level and address stigma
related challenges, Nyante and Carpenter (2019) rec-
. Using videos of participants’ home situation and ommend community education with accurate knowl-
current main priorities to discuss in training: their edge on disability. Additionally, creating communities
stories as starting point. of support such as self-help groups has been described
as a powerful tool to not only support families to cope
. Discussion of priorities for the family and appropri- with experienced stigma and discrimination, but also
ate actions. with the experienced care burden (Bunning et al.,
2020). The benefits of social support and connecting
. Practical exercises, with the children present. with other families in similar situations have also
. Record practice with child on video during training been an outcome of this training needs assessment.

for caregivers to revisit. Family-centredness, peer support and environ-
. Vietnamese handouts: written for service providers, mental adaptations to support children’s participation
and performance in activities are key concepts to
visuals for caregivers. address in similar trainings to not only support the
involved stakeholders but also contribute to the devel-
Discussion opment of occupational therapy, be it in Vietnam or
other low- and below middle-income countries. One
Through the training needs assessment, we captured way to approach this, could be by involving not only
information on the challenges, needs, support and families and community health workers but also Viet-
wishes of children with disabilities, their families and namese occupational therapy students to collabora-
community health workers. We learned about their tively develop and conduct trainings. This could help
current and desired capacity around participation in strengthen occupational therapists’ roles in Vietnam
ADL and taking care of a child with a disability. This and highlight their value in supporting community-
provided a sufficient base for designing a training, based rehabilitation (Van der Veen, 2010). At the
which is the next step of the applied training cycle in
this project (Hasselqvist & Thomas, 2012). This pro-
cess also helped us support cultural fit of the training
and limit potential risks to share knowledge and skills
that may not be suitable for the mountain areas in Viet-
nam (Whalley Hammell, 2011).

Main concerns of stakeholders were the lack of infor-
mation about the child’s development, experienced
difficulties in supporting the child’s participation and per-
formance of ADLs, and caregivers’ challenges to

8 A. C. M. KESTER AND V. C. KAELIN

same time, this possibly helps to create job opportu- References
nities for future occupational therapists.
Anaby, D. R., Law, M. C., Majnemer, A., & Feldman, D.
Limitations (2016). Opening doors to participation of youth with
physical disabilities: An intervention study. Canadian
In our training needs assessment, we visited families indi- Journal of Occupational Therapy, 83(2), 83–90. https://
vidually. Having discussion with several families together doi.org/10.1177/0008417415608653
could have led to direct consensus about training needs.
However, individual visits allowed more insight into Binh, T. T., Phuong, V. H., & Thao, V. P. (2017). Ending
families’ situations, including their surrounding environ- stigma – assessment for the perspectives of people with dis-
ment. Another limitation was the need for language abilities. https://www.vn.undp.org/content/vietnam/en/
interpretation, which possibly led to a loss of key infor- home/library/democratic_governance/EndingStigma.
mation. To minimise this, we had the same interpreters html (report 2018)
throughout the whole process that were familiar with
working with foreign professionals and the MACDI’s Bogenschutz, M., Im, H., Liang, A., & Quyhn Luong, L. T.
pilot project. This familiarity with the aim of this training (2020). Vietnam and disability rights: Perspectives at the
needs assessment supported cultural adjustment of fol- time of ratification of the UN convention on the rights
low-up questions and interpretation. of persons with disabilities. International Journal of
Disability, Development and Education, 1–17. https://doi.
Even though our questions were open-ended and org/10.1080/1034912X.2020.1716958
neutral, it can be questioned whether we managed to
fully capture the needs of families. Ideally, several Brown, J. (2002). Training needs assessment: A must for
home visits by the interviewers to the families would developing an effective training program. Public
help in gaining more trust of the families. However, Personnel Management, 31(4), https://doi.org/10.1177/
working closely with the MACDI community health 009102600203100412
workers who knew the families very well, possibly sup-
ported the families to openly share their story. Bunning, K., Gona, J. K., Newton, C. R., Andrews, F., Blazey,
C., Ruddock, H., Henery, J., & Hartley, S. (2020).
Conclusion Empowering self-help groups for caregivers of children
with disabilities in Kilifi, Kenya: Impacts and their under-
As part of a community-based capacity development lying mechanisms. PLOS ONE, 15(3), e0229851. https://
project, we captured the voices of families of children doi.org/10.1371/journal.pone.0229851
with disabilities and local MACDI staff in Vietnam to
gain insight into their lives and to work towards partici- Burr, R. (2015). Vietnam’s children’s experiences of being
patory capacity development. The training needs assess- visually or hearing impaired. Disability and the Global
ment helped us to better understand the daily lives of South, 2(2), 590–602. https://disabilityglobalsouth.files.
these stakeholders as well as the local context to com- wordpress.com/2012/06/dgs-02-02-02.pdf
monly identify and strengthen knowledge and skills.
As occupational therapists, we feel well-equipped to Dexter, A., Tran Lien Phuong, J. P. D., Le Mai Khanh,
address the complexity of ADLs and participation D. T. H., & Erickson, M. (2009). Research report on chil-
within unique settings. dren with disabilities and their families in Da Nang.
http://www.unicef.org//Final_KAP_on_CHILDREN
Acknowledgements WITH DISABILITIES_in_Engl.pdf

We would like to thank all children, families, community Dsouza, S., Dung, P., Ramachandran, M., & Rege, S. (2018,
health workers, MACDI staff and RCI staff for sharing May 23). Capacity building for occupational therapy in
their experiences and opinions. Furthermore, we would Vietnam: An India-Vietnam collaboration for knowledge
like to thank Sylvie Suijkerbuijk and Michelle van Vliet, transfer to support contextually relevant occupational
occupational therapists and trainers of Butterfly Basket therapy education and practice [Conference session].
Foundation, Dr Ton Satink and Andrea Gurga for sharing WFOT Congress 2018, Cape Town International
their advice and expertise for this article. Convention Centre (CTICC), Cape Town, South Africa.
https://congress2018.wfot.org/downloads/abstracts/SE%
Disclosure statement 2036/Capacity%20building%20for%20occupational%
20therapy%20.pdf
No potential conflict of interest was reported by the author(s).
Duncan, M. (2009). Human occupation in the context of
ORCID chronic poverty and psychiatric disability [Doctoral disser-
tation, Stellenbosch University]. http://hdl.handle.net/
Vera Cinzia Kaelin http://orcid.org/0000-0003-1290-9441 10019.1/1120

Global Disability Rights Now. (n.d.). Disability in Vietnam –
Timeline. https://www.globaldisabilityrightsnow.org/
infographics/disability-vietnam

Hasselqvist, H., & Thomas, L. (2012). Manual, training needs
assessment and training outcome evaluation. https://
unhabitat.org/books/training-needs-assessment-and-
training-outcome-evaluation-in-and-urban-context/

Institute for Social Development Studies (ISDS). (2013). The
economical cost of living with disability and discrimination
in Vietnam. Cong Nhan Publishing House.

Kester, A., Dung, T. P., & Kottorp, A. (2018). Vietnamese
caregivers’ reflections on activities of daily life in relation
to the Pediatric Evaluation of Disability Inventory. WFOT
Congress 2018. https://congress2018.wfot.org/downloads/
abstracts/GP102/Vietnamese Caregivers Reflections on
Activities.pdf

WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 9

Kiling, I. Y., Due, C., Gyss, C., Li, D. E., & Turnbull, D. Shin, J., Nhan, N. V., Crittenden, K. S., Hong, H. T. D., Flory,
(2019). Intervention research addressing environmental M., & Ladinsky, J. (2006). Parenting stress of mothers and
risk threatening young children with disabilities in devel- fathers of young children with cognitive delays in
oping countries: A systematic review. Disability and Vietnam. Journal of Intellectual Disability Research, 50
Rehabilitation, 41(17), 1987–2005. https://doi.org/10. (10), 748–760. https://doi.org/10.1111/j.1365-2788.2006.
1080/09638288.2018.1509142 00840.x

Liberato, S. C., Brimblecombe, J., Ritchie, J., Ferguson, M., & Suarez-Balcazar, Y., Witchger Hansen, A. M., & Muñoz, J. P.
Coveney, J. (2011). Measuring capacity building in com- (2015). Transformative nature of global partnerships.
munities: A review of the literature. BMC Public Health, Occupational Therapy International, 22(3), 117–120.
11(1), 850. https://doi.org/10.1186/1471-2458-11-850 https://doi.org/10.1002/oti.1406

London School of Hygiene & Tropical Medicine (LSHTM). Trinh, T. (2011). Children with disability in AnGiang and
(n.d.). Getting to know cerebral palsy. https://www.lshtm. Dong Nai: Knowledge – attitude – practice. Report for
ac.uk/sites/default/files/2019-06/Getting-to-know- UNICEF Viet Nam.
cerebral-palsy-english.pdf
UNFPA. (2011). People with disabilities in Viet Nam. Key
Mackenzie, L., Coppola, S., Alvarez, L., Cibule, L., Maltsev, S., findings from the 2009 Viet Nam population and housing
Loh, S. Y., Mlambo, T., Ikiugu, M. N., Pihlar, Z., & census. https://vietnam.unfpa.org/sites/default/files/pub-
Sriphetcharawut, S. (2017). International occupational pdf/Disability_ENG.pdf
therapy research priorities. OTJR: Occupation,
Participation and Health, 37(2), 72–81. https://doi.org/ UNICEF. (2018). Children with disabilities in Viet Nam –
10.1177/1539449216687528 Findings of Viet Nam’s national survey on people with
disabilities 2016 - 2017. https://www.unicef.org/vietnam/
Magnusson, D., Sweeney, F., & Landry, M. (2019). Provision reports/children-disabilities-viet-nam
of rehabilitation services for children with disabilities liv-
ing in low- and middle-income countries: A scoping UNICEF. (2020). Mobile integrated early childhood develop-
review. Disability and Rehabilitation, 41(7), 861–868. ment. https://www.unicef.org/vietnam/mobile-integrated-
https://doi.org/10.1080/09638288.2017.1411982 early-childhood-development

Mestechkina, T., Son, N. D., & Shin, J. Y. (2014). Parenting Van der Veen, J. (2010). In V. Alders & R. B. Crouch (Eds.),
across cultures: Childrearing, motherhood and fatherhood Occupational therapy: An African perspective. Sarah
47 in non-western cultures, Science across cultures: The Shorten.
history of non-western science 7. H. Selin (ed.),
doi:10.1007/978-94-007-7503-9_5, © Springer Science + Vietnam Times. (2019). Vietnam has the first batch of bache-
Business Media Dordrecht 2014. lors in occupational therapy. Retrieved May 23, 2020, from
https://vietnamtimes.org.vn/vietnam-has-the-first-batch-
Mundi Index. (2018). Vietnam. Retrieved December 13, of-bachelors-in-occupational-therapy-10982.html
2018, from https://www.indexmundi.com/vietnam/
WFOT. (2017). Definition of occupational therapy. https://
Ngo, H., Shin, J. Y., Nhan, N. V., & Yang, L. H. (2012). www.wfot.org/resources/definitions-of-occupational-
Stigma and restriction on the social life of families of chil- therapy-from-member-organisations
dren with intellectual disabilities in Vietnam. Singapore
Medical Journal, 53(7), 451–457. https://www.sma.org. WFOT. (2020). About: Why we’re here. https://www.wfot.
sg/UploadedImg/files/SMJ/5307/5307a3.pdf org/about

Nyante, G. G., & Carpenter, C. (2019). The experience of Whalley Hammell, K. (2011). Resisting theoretical imperial-
carers of children with cerebral palsy living in rural areas ism in the disciplines of occupational Science and occu-
of Ghana who have received no rehabilitation services: A pational therapy. British Journal of Occupational
qualitative study. Child: Care, Health and Development, Therapy, 74(1), 27–33. https://doi.org/10.4276/
45(6), 815–822. https://doi.org/10.1111/cch.12706 030802211X12947686093602

Ritter, A. B., Terjesen, M. D., & Khuc, T. N. (2019). Autism Witchger Hansen, A. M. (2015). Crossing borders: A quali-
in Vietnam: Knowledge, training, and communication tative study of how occupational therapy educators and
barriers among professionals, educators, and caregivers. scholars develop and sustain global partnerships.
International Journal of School & Educational Occupational Therapy International, 22(3), 152–162.
Psychology, 7(2), 123–134. https://doi.org/10.1080/ https://doi.org/10.1002/oti.1401
21683603.2019.1572554
World Health Organisation. (2010). Introductory booklet:
Rosenthal, E., & Mental Disability Rights International. CBR guidelines. The World Bank. https://www.who.int/
(2009). The right of children with disabilities in Viet disabilities/cbr/guidelines/en/
Nan. Bringing Vietnam’s laws into compliance with the
UN convention on the rights of persons with disabilities. World Medical Association. (2013). WMA declaration of
https://www.driadvocacy.org/wp-content/uploads/ Helsinkin – Ethical principles for medical research invol-
UNICEF_final_legal_analysis_report_in_Vietnam2.pdf ving human subjects. https://www.wma.net/policies-post/
wma-declaration-of-helsinki-ethical-principles-for-
Salomone, E., Pacione, L., Shire, S., Brown, F. L., Reichow, B., medical-research-involving-human-subjects/
& Servili, C. (2019). Development of the WHO caregiver
skills training program for developmental disorders or Zuurmond, M., O’Banion, D., Gladstone, M., Carsamar, S.,
delays. Frontiers in Psychiatry, 10, 1–9. https://doi.org/ Kerac, M., Baltussen, M., Tann, C. J., Gyamah Nyante,
10.3389/fpsyt.2019.00769 G., & Polack, S. (2018). Evaluating the impact of a com-
munity-based parent training programme for children
with cerebral palsy in Ghana. PLoS ONE, 13(9),
e0202096. https://doi.org/10.1371/journal.pone.0202096