Abstract
Background/aim In South Africa, contextual factors have been identified as barriers to outdoor, unstructured play. The human immunodeficiency virus (HIV) and resulting progressive HIV encephalopathy (PHE) is a pandemic in this area, associated with development delays that are not addressed by highly active antiretroviral treatment (HAART). This study aimed to describe the playfulness in children with HIV and PHE on HAART living in challenging socioeconomic areas in South Africa aged 6 months to 8 years and to evaluate the feasibility and preliminary effectiveness of a play-informed, caregiver-implemented, home-based intervention (PICIHBI) for improving play. Methods A feasibility randomized control trial allowed for comparison of PICIHBI and conventional one-on-one occupational therapy interventions. Children were filmed playing pre-, mid-, and postintervention, using the Test of Playfulness (ToP) to assess playfulness. The PICIHBI comprised of 10 monthly sessions facilitated by an occupational therapist, involving group discussions with caregivers and periods of experiential play. Results Twenty-four children with HIV and/or PHE were randomized into one of the two intervention groups. Overall, the group (n = 24) had a median score of 0 (lowest item score) on nine of 24 ToP items and only had a median score of 3 (highest score) on two items. Pre- to postintervention overall ToP scores improved marginally for the PICIHBI group (n = 12) and the conventional group (n = 12). Between-group differences were not significant. The PICIHBI group demonstrated a significant increase in one ToP item score at midassessment. No significant ToP item changes were found in the conventional group. Conclusion Children with HIV were found to have the most difficulty on ToP items relating to the play elements of internal control and freedom from constraints of reality. The PICIHBI did not significantly improve children's play and was not more effective than the conventional intervention. Considerations for feasibility and effectiveness, including barriers to attendance, are discussed.
Highlights
Play is a primary childhood occupation and encompasses all aspects of a child’s early years and development [1, 2]
This study aimed to develop a play profile of children with human immunodeficiency virus (HIV) living in low socioeconomic contexts in South Africa and to understand whether a play-informed, caregiverimplemented, home-based intervention (PICIHBI) was feasible and showed preliminary effectiveness for developing children’s playfulness
This study described the playfulness levels of 24 children with HIV and progressive HIV encephalopathy (PHE) from challenging socioeconomic contexts attending a clinic within South Africa
Summary
Play is a primary childhood occupation and encompasses all aspects of a child’s early years and development [1, 2]. Caregivers were asked how they viewed their child’s development, learning, and play skills in relation to their peers. This information was utilised to gain a sense of sample characteristics and an understanding of play engagement that may influence implementation of playfulness principles from the PICIHBI within the home. ToP items are operationalised according to the definition of play across four elements: intrinsic motivation, internal control, freedom from constraints of reality, and skills related to framing (reading and responding to cues). Items are ranked on a four-point scale and rated during a fifteen-minute observation of a child’s free play. Some items may be rated “not applicable” if the child does not have adequate opportunity to demonstrate the particular playfulness skill during the 15-minute observation. The ToP has been used as an outcome measure in previous intervention studies involving children cerebral palsy, ADHD, and typically developing children [24,25,26,27]
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