Feasibility of Tiyanjane: A Family–School–Community Intervention Promoting Parental Involvement in the Education of Children with Disabilities in Malawi

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The research addresses an extremely momentous topic that provides relevant insights for international readers as well. One of the study’s strengths is its clear theoretical reasoning and its adaptation of international literature (standards and concepts) to examine an intervention in a local community. Another key strength is (in most cases) transparent description of data collection, the steps involved in developing the measurement tools, and the honest discussion of limitations and generalizability.

Suggestions:

1. The research refers to itself both as a feasibility study and as participatory research. I recommend clarifying their relationship more explicitly in the methodology section. Based on lines 104–113 and 487–496, it seems that the feasibility study includes participatory research. If this is the case, it may be worth stating this more clearly in the methodological section.
2. If the study defines itself as participatory research, it would be beneficial to elaborate on this concept using methodological literature, such as:
   • Cornwall, A., & Jewkes, R. (1995). What is participatory research? Social Science & Medicine, 41(12), 1667-1676.
   • Cargo, M., & Mercer, S. L. (2008). The value and challenges of participatory research: Strengthening its practice. Rev. Public Health, 29(1), 325-350.
   • Bergold, J., & Thomas, S. (2012). Participatory research methods: A methodological approach in motion. Historical Social Research, 191-222.
   • Pain, R., & Francis, P. (2003). Reflections on participatory research. Area, 35(1), 46-54.
3. The emphasis on culturally sensitive programs is an extremely valuable point. It would be beneficial to briefly elaborate on what a culturally sensitive program entails in the theoretical section.
4. Suggested literature into the theoretical part: Dan, B. A., Szűcs, T., Sávai-Átyin, R., Hrabéczy, A., Kovács, K. E., Ridzig, G., Pusztai, G. (2024). Narrowing the inclusion gap – teachers and parents around SEN students. International Journal of Inclusive Education, 1–27. https://doi.org/10.1080/13603116.2024.2361102
5. 72 children with disabilities – What is the precise definition of disabilities used in this study? There is a reference to it here: “None of the caregivers had a child with intellectual disabilities, a limitation we noted in our co-design paper, further underscoring the low enrolment of children with intellectual disabilities in the Malawian school system” (Musendo, Chirwa, et al. 2024). However, a clear definition could be recommended, as this is a key concept in the study.
6. The selection process of parents/caregivers should be discussed separately from that of other participants to avoid complicating/tangling eligibility criteria, which currently affects the study’s methodological transparency (which is high in the rest of the study).
7. 72 children with disabilities – This number represents the entire population of children with disabilities attending the school under study (an interviewee mentioned 60). Of these, data collection was conducted for parents/caregivers of 13 children. I suggest clarifying how these 13 parents (of 13 children?) were selected from the 72. Additionally, given that some families had multiple children, and some were single-parent or other type households, how many people belonged to the parent/caregiver population? It is stated in the manuscript that willingness to participate was a key selection criterion. How were the 33 potential parents/caregivers identified? Do they represent the entire population of parents/caregivers of the 72 children? Or were they, for example, the more open and cooperative parents? While this is implied in the text, it would be beneficial to more explicitly reflect on this in the methodology section.
8. Inclusion criteria or eligibility criteria? Both terms are used. Is there a difference or are they used as synonyms?
9. The authors’ reflection on their roles is highly commendable. However, it could be further clarified how the researchers and the study authors were connected to the Tiyanjane program and its implementers. While the outsider perspective is stated, expanding on this slightly is recommended.
10. The conclusion should highlight findings that are applicable to actors in other countries. Even if the context varies, formulating cross-culturally relevant conclusions would further enhance the study’s international impact. This could include references to key points mentioned in the introduction.
11. Formatting suggestions:

• The following sentence is difficult to interpret; reordering the words might help:
  “The minimum expected target number of participants (13 caregivers and 12 families) was Tiyanjane.”
• Spaces need to be added in multiple locations (e.g., lines 201, 242, 254 before or after citation brackets).
• A full stop is missing at the end of line 213.

1. Reference list:

• Some inconsistencies need correction. Duplicate years for Crowe et al.
• DOI formatting for Epstein (2018), Moreau-Wiebels (2021), and Smith et al. (2023) not follows the standard format.
• In Appendix A, Bowen could be cited.

Overall, after refinement, the manuscript could become a very valuable contribution to an extremely significant topic.

Author Response

Our Response to Peer Reviewer 1

Overall Comment:

The research addresses an extremely momentous topic that provides relevant insights for international readers as well. One of the study’s strengths is its clear theoretical reasoning and its adaptation of international literature (standards and concepts) to examine an intervention in a local community. Another key strength is (in most cases) transparent description of data collection, the steps involved in developing the measurement tools, and the honest discussion of limitations and generalizability.

Response: Thank you for your compliments and for your review of our paper.

 

Our Response to Peer Reviewer 1

Comment 1:

The research refers to itself both as a feasibility study and as participatory research. I recommend clarifying their relationship more explicitly in the methodology section. Based on lines 104–113 and 487–496, it seems that the feasibility study includes participatory research. If this is the case, it may be worth stating this more clearly in the methodological section. If the study defines itself as participatory research, it would be beneficial to elaborate on this concept using methodological literature, such as:

Cornwall, A., & Jewkes, R. (1995). What is participatory research? Social Science & Medicine, 41(12), 1667-1676.

Cargo, M., & Mercer, S. L. (2008). The value and challenges of participatory research: Strengthening its practice. Rev. Public Health, 29(1), 325-350.

Bergold, J., & Thomas, S. (2012). Participatory research methods: A methodological approach in motion. Historical Social Research, 191-222.

Pain, R., & Francis, P. (2003). Reflections on participatory research. Area, 35(1), 46-54.

Response 1:

We have clarified in the methodology section that this is primarily a feasibility study that intentionally incorporates participatory research methods to ensure cultural relevance and stakeholder engagement. To elaborate on our participatory approach, we have included some more recent methodological literature that aligns with contemporary best practices in participatory research (Bergold & Thomas, 2012; Scher et al., 2023; Vaughn & Jacquez, 2020). While we acknowledge the seminal contributions of Cornwall and Jewkes (1995), Pain and Francis (2003), and Cargo and Mercer (2008), we have chosen to focus on more recent studies to reflect current methodological developments and recommendations.

Comment 2:

The emphasis on culturally sensitive programs is an extremely valuable point. It would be beneficial to briefly elaborate on what a culturally sensitive program entails in the theoretical section. Suggested literature into the theoretical part: Dan, B. A., Szűcs, T., Sávai-Átyin, R., Hrabéczy, A., Kovács, K. E., Ridzig, G., Pusztai, G. (2024). Narrowing the inclusion gap – teachers and parents around SEN students. International Journal of Inclusive Education, 1–27. https://doi.org/10.1080/13603116.2024.2361102

Response 2:

Thank you for highlighting the importance of clearly defining what we mean by a "culturally sensitive programme." We have included a brief elaboration on this concept within our theoretical framework, aligning with contemporary understandings provided by Dan et al. (2024). We have also added Degnan A, (et al)  The nature and efficacy of culturally-adapted psychosocial interventions for schizophrenia: a systematic review and meta-analysis. Psychol Med. 2018 Apr;48(5):714-727. doi: 10.1017/S0033291717002264 as it was also relevant to support your observation.

Comment 3:

72 children with disabilities – What is the precise definition of disabilities used in this study? There is a reference to it here: “None of the caregivers had a child with intellectual disabilities, a limitation we noted in our co-design paper, further underscoring the low enrolment of children with intellectual disabilities in the Malawian school system” (Musendo, Chirwa, et al. 2024). However, a clear definition could be recommended, as this is a key concept in the study.

Response 3:

We have clarified that in our study, we used the definition aligned with the UNCRPD, where disability is understood as a long-term physical, mental, intellectual, or sensory impairment that, when combined with various barriers, may hinder full and effective participation in society on an equal basis with others (UNCRPD, 2006). This has been placed after our mention of children with disabilities as suggested.

Comment 4:

The selection process of parents/caregivers should be discussed separately from that of other participants to avoid complicating/tangling eligibility criteria, which currently affects the study’s methodological transparency (which is high in the rest of the study).

Response 4:

We have updated the manuscript to explain how parents/caregivers and other participants were selected. We have added more information in Table S2 that describes the intervention in detail.

Comment 5:

72 children with disabilities – This number represents the entire population of children with disabilities attending the school under study (an interviewee mentioned 60). Of these, data collection was conducted for parents/caregivers of 13 children. I suggest clarifying how these 13 parents (of 13 children?) were selected from the 72.

Response 5:

Thank you for your feedback. We would like to clarify that the 72 children with disabilities at Kalambwe Primary School represented the total population of children with disabilities during the study period (we have corrected the inaccuracy noted of 60 participants – thank you). From this group, we selected 13 parents/caregivers for the pilot intervention based on their eligibility according to the established inclusion criteria, as well as their availability and consent. We have given clearer description and we have referenced the reader to Supplementary Figure S1 where we have detailed info on eligibility for each group.

 

Comment 6:

Additionally, given that some families had multiple children, and some were single-parent or other type households, how many people belonged to the parent/caregiver population? It is stated in the manuscript that willingness to participate was a key selection criterion. How were the 33 potential parents/caregivers identified? Do they represent the entire population of parents/caregivers of the 72 children? Or were they, for example, the more open and cooperative parents? While this is implied in the text, it would be beneficial to more explicitly reflect on this in the methodology section.

Response 6:

We have clarified that the 25 caregivers selected for possible participation do not represent all caregivers of the 72 children with disabilities at Kalambwe Primary School. Potential participants were identified for screening through collaboration with teachers and local gatekeepers, using screening checklists to ensure they met the eligibility criteria for participation - taking into account their eligibility, the ages of their ‘children’ (e.g., some were over 18), as well as their interest, willingness, and logistical feasibility. 

Comment 7:

Inclusion criteria or eligibility criteria? Both terms are used. Is there a difference or are they used as synonyms?

Response 7:

Thank you for the observation. We have revised the manuscript to consistently use the term “eligibility criteria” to improve clarity.

Comment 8:

The authors’ reflection on their roles is highly commendable. However, it could be further clarified how the researchers and the study authors were connected to the Tiyanjane program and its implementers. While the outsider perspective is stated, expanding on this slightly is recommended.

Response 8:

Thank you for this helpful suggestion. We have now added a short clarification to Section 2.7 to explain the lead author’s prior collaboration with the implementing partners and how this informed, but did not compromise, the independence of the research.

 

Comment 9:

The conclusion should highlight findings that are applicable to actors in other countries. Even if the context varies, formulating cross-culturally relevant conclusions would further enhance the study’s international impact. This could include references to key points mentioned in the introduction.

Response 9:

We agree that highlighting the potential relevance of our findings beyond the Malawian context is important. However, as this is a small-scale feasibility study conducted in a specific setting, we feel it is premature to make broad cross-cultural claims. Nevertheless, we have added a sentence to the conclusion acknowledging that while our findings are context-specific, they may offer insights for similar settings seeking to strengthen inclusive education through community-based approaches.

Comment 10: Formatting suggestions:

Comment 10a

The following sentence is difficult to interpret; reordering the words might help: “The minimum expected target number of participants (13 caregivers and 12 families) was Tiyanjane.”

Response:

We have revised the sentence to improve clarity. It now reads: The Tiyanjane intervention met its target, engaging 13 caregivers from 12 families, four teachers, and four community leaders as participants.

 

Comment 10b

Spaces need to be added in multiple locations (e.g., lines 201, 242, 254 before or after citation brackets).

Response:

Amended – thank you.

 

Comment 10b

A full stop is missing at the end of line 213.

Response:

Corrected – thank you.

Comment 10c

Reference list: (a) Some inconsistencies need correction. Duplicate years for Crowe et al.; (b) DOI formatting for Epstein (2018), Moreau-Wiebels (2021), and Smith et al. (2023) not follows the standard format; and (c) In Appendix A, Bowen could be cited

 

Response :

We have updated the reference list accordingly – than you.

 

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors, thank you for the opportunity to learn about your experience.

The work you are presenting requires a major revision. I found it difficult to read and understand.

First, the stated research objective requires a more operational approach. Second, different methods are mixed, leaving me unclear as to how the analytical procedures are carried out or the specific objective pursued with each analysis. Regarding the elements involved in the analyses, I have not been able to clearly identify them in the method section. I have not been able to identify the objectives of the results presented, nor the analytical elements and procedures involved.

You should review the formal aspects of the work, for example, the authority citations. The use of XXXX in the text does not seem necessary. Please note that, although the research may have generated several research reports (articles), this work should be readable without the need to consult other external works.

It is stated that a systematic review of the literature has been conducted beforehand; it is suggested that you review the introduction. You may be asked to include references to other works in line with yours that serve as a reference.

The use of statistical techniques is presented in the reverse order of what is expected. For example, the normality test justifies the use of the t-test. On the other hand, the number of participants (21) may seem very small.

Author Response

Thank you for your feedback and time to review our paper.

 

Comment 1:

 The work you are presenting requires a major revision. I found it difficult to read and understand. First, the stated research objective requires a more operational approach.

Response :

Thank you for your feedback. We recognize the importance of expressing our research objective in clearer operational terms. Our objective was to assess the feasibility of the Tiyanjane intervention through Bowen’s framework, and we have edited the manuscript to communicated this more effectively by detailing what we measured and how we did it. We have revised the research objective in the introduction to clarify that the study looked at participant recruitment, program delivery, participant engagement, and initial changes in parenting practices and social support.

 

Comment 2:

Second, different methods are mixed, leaving me unclear as to how the analytical procedures are carried out or the specific objective pursued with each analysis. Regarding the elements involved in the analyses, I have not been able to clearly identify them in the method section. I have not been able to identify the objectives of the results presented, nor the analytical elements and procedures involved.

Response :

Thank you for your feedback. We have revised Section 2.6 (Data Management and Analysis) to clearly separate the qualitative and quantitative analysis methods. We also explain how each type of data has contributed to evaluating specific feasibility areas, following Bowen’s principles framework.

Comment 3:

You should review the formal aspects of the work, for example, the authority citations. The use of XXXX in the text does not seem necessary. Please note that, although the research may have generated several research reports (articles), this work should be readable without the need to consult other external works.

Response :

Thank you for this helpful comment regarding the formal aspects of the manuscript and the use of anonymised placeholders such as “XX.” We would like to clarify that the editorial team introduced these placeholders as part of the anonymisation process to support double-blind peer review and will be replaced with full references during final revisions. We agree that the manuscript should be readable as a stand-alone article.

We have made minor but meaningful adjustments in key sections to improve self-containment and readability. For example, we revised the statement, “The details of Tiyanjane’s intervention co-development process and content have been published elsewhere” to now read: “The intervention content was informed by earlier community consultations conducted in Malawi as part of the Tiyanjane project, where caregivers and teachers shared needs around parental involvement in supporting their children’s development and education.”

Similarly, in the Positionality and Reflexivity section, we revised: “The lead researcher was involved in previous research related to the programme” to now read: “The lead researcher had previously collaborated with CCAP’s Inclusive Education Programme and Sense Scotland in an evaluation capacity, which helped shape the research focus.”

 

Comment 4:

It is stated that a systematic review of the literature has been conducted beforehand; it is suggested that you review the introduction. You may be asked to include references to other works in line with yours that serve as a reference.

Response :

Thank you for your suggestion. We understand that it's important to place our study in the context of existing research. In response, we have updated the introduction to include references from our previous systematic review and other important international studies. These updates help clarify our research focus and connect it to current evidence on parental involvement interventions for children with disabilities.

Comment 5:

The use of statistical techniques is presented in the reverse order of what is expected. For example, the normality test justifies the use of the t-test. On the other hand, the number of participants (21) may seem very small.

Response :

Thank you for this feedback. We agree that the statistical reporting can be improved by presenting the normality test results before describing the t-test, as this better aligns with standard reporting practices. We have revised the Data Analysis section to clarify that the paired-sample t-test was employed based on the Shapiro–Wilk test results that confirmed normality.

We recognise that a sample of 21 participants is a small sample size for statistical generalisation. However, since this is a feasibility study, our aim was not to test impact but to explore preliminary signals of efficacy and assess the qualitative components of acceptability, practicality, demand and implementation. The sample size was suitable for the exploratory nature of this study, and we have clarified this in the methods and limitations sections.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

I agree with the changes and the responses to the review, and I accept the study. Congratulations to all authors on this truly valuable study!

Author Response

Thank you for the review and comments stating that: I agree with the changes and the responses to the review, and I accept the study. Congratulations to all authors on this truly valuable study!

 

We are thankful for your kind response and compliments. 

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors, thank you for your responses. The text of your work is more readable and has improved significantly.

The experience presented here is an initiative of great social value. The authors' commitment to improving the lives of people with disabilities and their families in Malawi is evident. My sincere congratulations for your contribution to making life easier for those most in need.

I think the work you present is of great interest. Your research report might be clearer if you:

1. They explicitly include the research objective in the body of the article, for example, at the end of the introduction section.
2. In the method section, include a table in which you identify the analysis codes that correspond to each category or area of analysis (qualitative analysis). Briefly describe the meaning of each one.
3. Indicate the range of the PAFAS questionnaire and MSPSS scale measures, as well as what higher or lower scores mean. This will allow the reader to interpret the mean values and standard deviations presented in Tables 2 and 3. Briefly define the meaning of the items in both questionnaires (this will facilitate understanding of the results presented).
4. Regarding the results of the qualitative analysis, it may be helpful to include a table presenting representative samples of participants' opinions for the different categories. If you found relationships between categories, include evidence of those relationships.
5. Regarding the results of the quantitative analysis, briefly comment on the results presented in each table (for example, prior to presenting each table).
6. This section could be organized taking into account the headings presented in the results section. The aim would be to discuss the results of each section explicitly.
7. Review citations and references. You can find a guide at https://www.mdpi.com/authors/references

Specifically: https://mdpi-res.com/data/the-mdpi-apa-reference-list-and-citations-style-guide-2024.12-online.pdf

For example, it may be necessary to review citations such as:

Wondim, Asrat Getahun, and Golga 2021

Alflasi , Al- Maadadi , and Coughlin 2018

Smith, van der Groen, and Learmonth 2023

Musendo , Chirwa , et al. 2024

And references like:

Wang, Yongli, Qin Wan, Zhaoming Huang, Li Huang, and Feng Kong. 2017. 'Psychometric Properties of Multi-Dimensional Scale of Perceived Social Support in Chinese Parents of Children with Cerebral Palsy'. Frontiers in Psychology (NOV). Frontiers Media SA: 312490. doi:10.3389/FPSYG.2017.02020.

 

Author Response

We thank the reviewers for their second manuscript review and recognition. We also appreciate Reviewer 2's additional comments and suggestions to enhance clarity in the research article. Below are our responses detailing the changes we implemented and the necessary clarifications.

Reviewer Two’s Comment 1

They explicitly include the research objective in the body of the article, for example, at the end of the introduction section.

 

Response to Comment 1

We confirm that the research objective is explicitly presented in lines 103 to 112, the final paragraph of the introduction. We believe this is well-placed and provides depth to assist the reader in understanding the study design in the following subsection.

 

Reviewer Two’s Comment 2

In the method section, include a table in which you identify the analysis codes that correspond to each category or area of analysis (qualitative analysis). Briefly describe the meaning of each one.

 

Response to Comment 2

Thank you. We have further enriched our Supplementary table S1 by adding a column with the meanings of each analysis code used in the results section of our manuscript. However, we have included the analysis codes corresponding to each category and area of analysis within the qualitative analysis as subheadings in the results section. We believe that this clearly outlines the data for the reader, and that including an additional table within the text will lead to unnecessary repetition.

 

Reviewer Two’s Comment 3

Indicate the range of the PAFAS questionnaire and MSPSS scale measures and what higher or lower scores mean. This will allow the reader to interpret the mean values and standard deviations in Tables 2 and 3. Briefly define the meaning of the items in both questionnaires (this will facilitate understanding of the results presented).

Response to Comment 3

We appreciate the reviewer’s suggestion to improve the clarity of our measures. We have revised Section 2.5.1 (Quantitative Measures) to include additional detail on the scoring range and interpretation of PAFAS and MSPSS tools. See lines between 229 and 245.  In the Results section (lines 513–517 and 537 – 542, we added more details to interpret the post-intervention MSPSS mean values using the tools’ standard thresholds, as recommended by the reviewer.

 

Reviewer Two’s Comment 4

Regarding the results of the qualitative analysis, it may be helpful to include a table presenting representative samples of participants' opinions for the different categories. If you found relationships between categories, include evidence of those relationships.

 

Response to Comment 4

Thank you for this suggestion. However, after considering the comment, we have already provided a detailed analysis and representative participant quotes (opinions). Relationships between categories are integrated directly under each subtheme in the narrative to maintain flow and contextual coherence. We believe an additional table of representative opinions would not add value, could risk redundancy, and may disrupt the flow of the narrative, as the findings are already thoroughly presented and discussed in the text.

 

Reviewer Two’s Comment 5

Regarding the results of the quantitative analysis, briefly comment on the results presented in each table (for example, prior to presenting each table).

 

Response to Comment 5

These brief comments are under subsections 3.5.1 and 3.5.2 on pages 8 and 9. We have further enriched these as we revised the above comments.

 

Reviewer Two’s Comment 6

This section could be organized according to the headings presented in the results section. The aim would be to discuss the results of each section explicitly.

 

Response to Comment 6

We understand that this suggestion relates to the discussion. We believe we have addressed the results of each section succinctly and explicitly, without repetition, and hence focused on highlighting key points for the reader.

 

Reviewer Two’s Comment 7

Review citations and references. You can find a guide at https://www.mdpi.com/authors/references

Specifically: https://mdpi-res.com/data/the-mdpi-apa-reference-list-and-citations-style-guide-2024.12-online.pdf

For example, it may be necessary to review citations such as:

Wondim, Asrat Getahun, and Golga 2021

Alflasi , Al- Maadadi , and Coughlin 2018

Smith, van der Groen, and Learmonth 2023

Musendo , Chirwa , et al. 2024

And references like:

Wang, Yongli, Qin Wan, Zhaoming Huang, Li Huang, and Feng Kong. 2017. 'Psychometric Properties of Multi-Dimensional Scale of Perceived Social Support in Chinese Parents of Children with Cerebral Palsy'. Frontiers in Psychology (NOV). Frontiers Media SA: 312490. doi:10.3389/FPSYG.2017.02020.

 

Response to Comment 7

Thank you once again. We have corrected the references. 

Round 3

Reviewer 2 Report

Comments and Suggestions for Authors

Review the citations in the text, for example: Klein-Cox, Tobin, and Denby, 2023; Wondim, Asrat Getahun, and Golga, 2021; Alflasi, Al-Maadadi, and Coughlin, 2018; ...