Wheelchair Provision for Children with Disabilities in Rural Thailand: The Roles of Family Support and Environmental Barriers in Daily Participation

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This exploratory study examined how the provision of wheelchairs shaped daily activities and opportunities for participation for two children with disabilities living in rural areas of northeastern Thailand. A qualitative multiple case study design was employed. The study clearly presents its aims, methodology, data collection procedures, ethical considerations, findings, and directions for future research. The research trajectory is well articulated.

A key priority for future research is to clarify how families can be supported in making informed decisions regarding school attendance and community participation, as well as to identify ways of providing psychological and practical support, particularly in relation to environmental access factors. 

The study demonstrates that even the basic assistive tool of a wheelchair does not provide sufficient benefit in environments that lack accessibility and, potentially, social awareness among users and the wider community. It would have been helpful to include information regarding the users’ socioeconomic and living conditions, supported by more detailed data, as well as to examine whether the availability of technology could objectively exist and potentially support distance education.

Alongside its findings, the study may also be seen as highlighting a possible alternative direction or proposal for future approaches.

Τhe study constitutes a comprehensive piece of research in relation to the aims that were set.

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

The manuscript addresses a relevant and underexplored topic, offering a rich and well-contextualized account of the experiences of children with disabilities in rural Thailand. The study is firmly grounded in local socio-cultural and institutional realities, and the use of the ICF and Community-Based Rehabilitation frameworks, together with standardized instruments such as WeeFIM, represents a clear methodological strength.

However, the manuscript would benefit from a more explicit articulation of its theoretical contribution. Although the ICF and CBR frameworks are consistently referenced, they are employed largely in a descriptive or instrumental manner, rather than being integrated into a clearly articulated analytical problem. In particular, the family emerges repeatedly in the data as a central factor shaping children’s participation, yet its ambivalent role—as both a source of support and a potential constraint—is not sufficiently conceptualized or discussed as an original contribution to the existing literature.

The abstract reflects this broader issue. While it is coherent and well structured, it is overly oriented toward practical implications and does not clearly articulate the study’s theoretical focus. The very small sample size is not explicitly problematized, and the strictly exploratory and illustrative nature of the analysis is not sufficiently emphasized. In addition, the methodological description remains largely declarative: the reference to “descriptive analyses” does not clarify the type of qualitative analysis conducted, the integration of different data sources, or the comparative logic between cases.

The introduction provides a solid overview of the institutional and educational context of rural Thailand, but it remains predominantly descriptive. The relationships among educational structures, environmental barriers, and family caregiving practices are presented, yet they are not sufficiently problematized as explanatory mechanisms underlying exclusion or limited participation. Furthermore, the research gap is formulated in rather general terms, without clarifying whether the gap is primarily conceptual, methodological, or contextual, which weakens the study’s positioning within the international literature.

The methodology section is clearly organized and transparent in terms of data collection procedures, but the analytical strategy remains insufficiently conceptualized. The rationale for selecting the two cases is not articulated in analytical terms, and the integration of interview data with WeeFIM and ICF assessments is not explained within a coherent analytical framework. Limitations related to the cultural adaptation of the instruments are acknowledged, but they are not sufficiently discussed in relation to the interpretation of the findings.

The results are rich and relevant, yet they are presented mainly in a descriptive manner, with an occasionally unclear boundary between empirical findings and interpretation. The comparative potential of the multiple-case study design is underutilized, and the relationships among individual functioning, the physical environment, available services, and family decision-making are not systematically analyzed as emerging patterns.

The discussion is well informed and appropriately grounded in the existing literature, but it tends to reinforce already established findings rather than clearly highlighting what is new or distinctive in relation to previous studies. The analysis of environmental constraints and the role of the family is pertinent, yet largely unidirectional, and would benefit from a deeper exploration of decision-making processes and critical moments of educational transition. References to the capability approach and autonomy are promising, but they remain insufficiently connected to the empirical data.

The sections on limitations and conclusions are written in an honest and cautious manner, but they remain largely descriptive. Limitations are not fully integrated into a deeper methodological reflection, and future research directions are formulated in general terms, without clearly deriving from the gaps identified in the present analysis. The conclusions tend to reiterate broad normative recommendations rather than explicitly synthesizing the key insights and the study’s distinct contribution.

Finally, the reference list provides an adequate institutional and contextual foundation, but it is dominated by older sources and normative documents. The inclusion of more recent empirical studies would strengthen the theoretical positioning and international relevance of the manuscript.

Overall, the study has a solid empirical basis and clear contextual relevance, but it would benefit from a series of revisions aimed at clarifying its theoretical contribution, strengthening its analytical logic, and more explicitly articulating its added value in relation to the existing literature.

Best regards,

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Dear Authors,
The submitted article has been carefully prepared and appears to be appropriate in terms of its background, objectives, and methodology. However, I would like to make some suggestions for your consideration and further improvement.

 

Abstract

The gap statement in line 19, that is, "little is known," is excessively broad. The claim requires refinement with respect to its scope and the precise nature of the unknown elements.

 

Introduction

The overgeneralization of the cultural explanation, as illustrated in lines 63–64, appears to be a form of stereotyping. To avoid such misrepresentations, it is essential to employ precise language and provide robust evidence to support claims.

 

Materials and Methods

The establishment of explicit and reproducible inclusion criteria would be a valuable contribution to the field. The present specification in lines 173–177 is excessively vague.

The analysis of data is underspecified for qualitative research. This is due to the absence of an analytic procedure, the software package used for qualitative data analysis, and other relevant details. A thorough exposition of the methodology employed in processing the interviews is imperative. This methodology encompasses the recording, transcription, coding, identification of themes, and triangulation of the data. Furthermore, the translation process remains unaddressed.

A discussion is warranted regarding the potential impact of social desirability bias in instances where the presence of SEC/NGO entities may have influenced the responses of study participants.

It seems that the WeeFIM scoring reliability is not reported adequately (see section 2.4). Given the presence of two raters, it is imperative to document the management of these evaluations, the methods employed to ensure inter-rater agreement, and the analyses conducted to ensure reliability.

Similarly, it is evident that the rating procedure and evidence base for each score on the ICF Environmental Factors Checklist are not sufficiently detailed, necessitating a more thorough description.

A minor inconsistency is observed in Table 1 when the terms "Fitting" and "Provision" are utilized. It is imperative to employ a single term in a consistent manner.

 

Results

As illustrated in Table 2, the data is not consistently labeled, which hinders the clarity of the figures. Specifically, it is not evident whether the data corresponds to the baseline or subsequent follow-up assessments. Moreover, the data presented in Table 2 is limited to a single score for each item. It would be beneficial to consider the inclusion of both baseline and follow-up values to enhance the comprehensiveness of the analysis.

Despite conducting a qualitative study, the authors do not offer any direct quotations to support their claims. It is imperative that relevant claims concerning emotions, confidence, and preferences be incorporated.

A potential contradiction emerges when the subject's reliance on a wheelchair is reported (line 139) while concurrently asserting that the subject was "independent using crawling or a walker" (line 238). It is imperative to maintain uniformity in this regard.

 

Discussion

The section addressing limitations fails to mention the exclusion of non-use and declined cases, which can be the most significant limitation. It is imperative to incorporate selection bias explicitly in order to ensure the validity of the study's findings.

The discussion introduces the capability approach, but it does not provide a comprehensive explanation, definition, or adequate framing of the concept. Kindly provide such information.

 

In conclusion, the manuscript has the potential to contribute to the field. With the above improvements, its impact could be further enhanced. Thank you for your consideration of these comments, and best wishes for your future work.

Sincerely,

Author Response

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Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

The authors have substantially addressed my previous comments. The revised version is more coherent, methodologically transparent, and conceptually better positioned. The clarification of the analytical strategy and the more explicit articulation of the ambivalent role of family support represent meaningful improvements and reflect a consistent effort to strengthen the manuscript.

However, the extremely limited empirical base (two cases) constitutes a major methodological limitation that requires a more explicit positioning in relation to the level of claims advanced. In its current form, a tension emerges between the ambition of the theoretical positioning and the inferential capacity permitted by a design based on only two cases.

More specifically, the manuscript should more rigorously clarify:

• the epistemological status of the conclusions (illustrative, exploratory, hypothesis-generating, or intended as theoretical refinement);

• the level of inference considered justified on the basis of two cases;

• the extent to which the conceptual claims can be sustained as broader theoretical propositions versus context-bound, emergent insights;

• the explicit limits of transferability.

As currently formulated, the conceptual contribution may be interpreted as having a stronger explanatory force than is warranted by the empirical foundation. A clearer adjustment of the level of conceptual claims is necessary to ensure proportionality between the empirical base and the theoretical assertions advanced. Such clarification is essential to safeguard the internal coherence and methodological rigor of the manuscript.

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Dear Authors,

I would like to express my appreciation for your efforts to revise the manuscript. Your revisions demonstrate that you have carefully considered all of the comments, and you have adequately addressed these issues. After reviewing the updated manuscript, I am pleased to say that the revisions meet the expectations I set forth in my previous comments. The changes you made improved the clarity and overall impact of the study. The manuscript is now refined to a standard that effectively communicates the research findings and provides valuable insights to the field.

Sincerely,

Author Response

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Author Response File: Author Response.pdf