Children with developmental disabilities (DDs) face immense global challenges, including in African countries with high prevalence rates (Arora et al. 2022; Olusanya et al. 2018). Developmental disabilities are a group of conditions because of impairment in physical, learning, language or behaviour areas that begin during the developmental period and typically last throughout a person’s lifetime. These include intellectual disabilities, autism spectrum disorders, cerebral palsy and other neurological disorders. Globally, it is estimated that 13.9% of children aged 2–17 years have DDs, with prevalence rates varying across regions (Olusanya et al. 2022). In low- and middle-income countries, particularly in Africa, the prevalence is thought to be higher because of factors such as malnutrition, limited access to healthcare and higher rates of birth complications. Caregivers shoulder substantial burdens, facing barriers such as limited access to services, resources and cultural stigma (Abuga et al. 2022; Akpeke, Agbemavi & Adde 2024; Nyoni 2021; Olaitan & Olaitan 2022). In our review, caregivers are defined as the primary individuals responsible for the daily care and support of children with DD. This includes biological parents, adoptive parents, grandparents and other family members who serve as primary caregivers. While we acknowledge that professionals and community members may play supporting roles, our review focuses primarily on family caregivers who bear the main responsibility for the child’s care. Cultural factors significantly influence caregiver experiences and the delivery of healthcare interventions. These include traditional beliefs about the causes of disabilities, which may attribute conditions to curses or spiritual factors, influencing help-seeking behaviours (Nyoni 2021). Additionally, community attitudes towards disability often result in social exclusion of both children and their caregivers, while family structures and gender roles can impact the distribution of caregiving responsibilities (Zuurmond et al. 2019). Healthcare interventions offer potential support through education, counselling, peer networks (Azad et al. 2022; Catalano, Holloway & Mpofu 2018), but evidence on effectiveness and cultural relevance is limited, especially in South African contexts (Constantino et al. 2022; Nyoni 2021). While some studies explore caregiver interventions in Africa (Yousafzai et al. 2022; Abuga et al. 2022), more research on context-specific, culturally relevant interventions is needed. Our systematic review aims to comprehensively explore existing healthcare interventions tailored to strengthen capabilities of caregivers of children with DD. Well-being for caregivers of children with DDs encompasses multidimensional aspects of their lives, including physical health, psychological resilience, social connectedness and economic stability (Boehm, Carter & Taylor 2021; Morin et al. 2023). It involves not only the absence of distress but also the presence of positive experiences, coping abilities and quality of life while managing the complex responsibilities of caring for a child with developmental needs (Duran, Grimsey & Arber 2022; Lunsky et al. 2021).

Interventions for parents of children with DDs strategically enhance human capabilities by leveraging multidimensional support mechanisms. These interventions focus on skill development, psychological support and empowerment, systematically transforming parental capabilities through targeted approaches (Lancaster et al. 2023; Provenzi et al. 2021). By providing contextualised training, peer support networks and practical learning strategies, interventions aim to improve parent–child interactions, reduce psychological stress and build emotional resilience (Koly et al. 2021; Szlamka et al. 2022). The most effective interventions incrementally develop caregivers’ problem-solving skills, communication strategies and self-confidence, ultimately enabling them to more effectively support their children with DDs while simultaneously enhancing their own psychological and practical capabilities (Riches et al. 2023).

Strengthening caregiver capabilities through targeted healthcare interventions has significant implications for reducing long-term social and economic burdens. When caregivers are better equipped with skills and support, there are measurable improvements in children’s developmental outcomes (Masi et al. 2021), decreased healthcare utilisation costs (Wang et al. 2022), reduced family disruption and increased caregiver workforce participation (Lavelle et al. 2023). Caregiver capability refers to the dynamic combination of knowledge, skills, psychological resources and social supports that enable caregivers to effectively meet the complex needs of children with DDs (Derguy et al. 2020; Masulani-Mwale et al. 2022). The capability approach, as applied to caregiving, recognises caregivers as agents who require certain functioning and freedoms to achieve well-being for themselves and their children (Lancaster et al. 2023; Provenzi et al. 2021). The economic impact of DDs extends beyond immediate healthcare costs to include lifetime support services, lost productivity and educational accommodations, estimated at significant costs that grow over time (Rogge & Janssen 2022). By investing in caregiver capabilities, interventions potentially mitigate these long-term societal costs while improving outcomes for both children and their families (Pickard et al. 2024).

A comprehensive search of electronic databases was conducted. Search terms included combinations of keywords related to caregivers, DDs, interventions and capabilities. The full search strategy was developed in consultation with a research librarian.

The search strategy aimed to find published and unpublished studies on the topic by searching databases such as PubMed, Ebsco host, Health Source, Sage and University of the Western Cape (UWC) database search, which was accessed via the UWC Library, using relevant search terms such as ‘healthcare’, ‘intervention’, ‘disability’, ‘developmental disability’, ‘human capabilities’, ‘interdisciplinary team approach’, ‘parents’, ‘caregivers’ and ‘children’. The identified articles and legislative frameworks were then screened to select relevant studies for our review.

Two independent reviewers screened titles and abstracts, followed by a full-text review of potentially eligible studies. Data extraction was conducted using a standardised form, capturing information on study characteristics, intervention details and outcomes. (Farajimakin 2024) The study selection adhered to PRISMA guidelines. From 303 initial records, 248 were screened after removing duplicates. A total of 207 records were excluded, leaving 41 for full-text review, as indicated in the flow diagram in Figure 1. Twenty-seven were further excluded based on predetermined criteria. Ultimately, 16 eligible studies were included in the systematic review, with data extracted into a structured table.

We synthesised 16 studies from nine countries (2014–2024) using various designs (qualitative, reviews, mixed methods, Randomized Controlled Trials (RCTs) to examine caregiver challenges and evaluate interventions for DDs. We conducted a systematic search process, starting with database searches using relevant keywords and then screened titles and abstracts, followed by full-text reviews to ensure studies met all inclusion criteria. This rigorous process yielded 16 studies meeting all criteria and relevant to our objectives. This outcome aligns with findings from Page et al. (2021) in their guidance on systematic reviews, which notes that strict criteria often lead to a focused set of studies. Similarly, Tricco et al. (2018) in the updated PRISMA statement highlight how the systematic review process typically narrows down a large initial pool of studies to a smaller, highly relevant set. This approach ensures a comprehensive yet focused selection of literature for analysis, as emphasised by Page et al. (2021) in the updated Cochrane Handbook for Systematic Reviews of Interventions. Findings integrated caregiver experiences, effective strategies, implementation considerations, intervention effects, common themes such as feasibility and acceptability, and contextual factors influencing effectiveness and implementation.

Studies for the review were selected according to the following criteria.

Ethical clearance to conduct this study was obtained from the University of the Western Cape Faculty of Community and Health Sciences Biomedical Science Research Ethics Committee on 17 March 2023 (No. BM23/1/10).

Our review identified several types of interventions designed to support caregivers. These included parent education programmes, counselling and mental health support, peer support groups, combined approaches and condition-specific interventions. Parent education programmes focused on enhancing parental knowledge and skills (Dababnah et al. 2021), often incorporating culturally relevant content in African contexts and delivered by trained local facilitators to ensure sustainability and community ownership (Trani et al. 2020). Counselling and mental health support interventions, including individual counselling, cognitive-behavioural therapy and psychotherapy, were employed to address caregiver stress and burden (Caicedo 2016). In African settings, these interventions often integrated traditional healing practices and involved extended family members in the process (Scherer, Verhey & Kuper 2022).

Several studies highlighted the effectiveness of peer support interventions, connecting caregivers with others in similar situations (Guralnick 2019). In African communities, these groups often leveraged existing social structures and community networks. Some interventions utilised a multifaceted approach, combining education, counselling and home visits to address diverse caregiver needs simultaneously (Masulani-Mwale et al. 2019). Certain studies focused on interventions tailored to specific disabilities, such as autism, addressing the unique challenges associated with conditions (Dababnah et al. 2021).

Our review analysed five key intervention approaches for enhancing caregiver capabilities. Parent educational programmes effectively built knowledge and skills through structured curricula, with greater success when incorporating practical skill-building rather than merely providing information. Counselling interventions addressed psychological impacts of caregiving, with individual counselling effective for specific psychological challenges and group counselling fostering shared problem-solving. Cultural framing significantly influenced engagement. Peer support interventions contributed uniquely through experiential knowledge-sharing and emotional validation, proving especially valuable in resource-constrained settings. Combined interventions demonstrated synergistic effects by integrating multiple support strategies, with flexible, tailored combinations showing robust improvements across caregiver capabilities. Condition-specific interventions effectively built specialised skills for particular DDs but were often less effective for broader psychosocial needs. Implementation success across all approaches depended on cultural adaptability, accessibility, trained facilitators, practical strategies, appropriate duration with follow-up, family involvement and addressing both immediate and long-term needs. The most promising interventions were contextually appropriate, addressed multiple needs and balanced immediate support with sustainable capability building.

The duration of interventions varied widely, ranging from short-term programmes lasting 6–8 weeks to long-term interventions spanning several months or even years. Short-term interventions typically focused on intensive parent education workshops, brief counselling interventions and time-limited peer support groups. Medium-term interventions often included ongoing parent training sessions, regular counselling appointments and facilitated peer support meetings. Long-term interventions frequently incorporated comprehensive family support programmes, ongoing mental health support, sustained peer support networks and regular home visits and follow-ups.

Content of the interventions typically covered education about specific DDs, strategies for managing challenging behaviours, techniques for promoting child development, stress management and self-care for caregivers, navigation of healthcare and education systems and building social support networks. In African settings, intervention content often emphasised integration of local cultural beliefs and practices, involvement of extended family and community members, addressing stigma and promoting community acceptance, strategies for managing resource limitations and empowering caregivers as advocates for their children.

These diverse interventions align with our study research question by demonstrating how healthcare approaches enhance caregiver capabilities across multiple domains, with the PICO elements clearly revealing that multicomponent, culturally adapted interventions produce the strongest improvements in caregiver knowledge, skills, psychological well-being and quality of life compared to standard care or single-approach interventions. These findings highlight the diverse range of interventions available to support caregivers of children with DD, with a growing emphasis on culturally adapted, holistic approaches, particularly in African contexts. The variety in duration and content reflects the complex, ongoing nature of caregiver support needs and the importance of tailoring interventions to specific cultural and community contexts.

Several studies (e.g. Studies 1, 2, 5, 9, 11, in Table 1) highlighted the importance of educational interventions enhancing parental knowledge, skills and empowerment (Dababnah et al. 2021; Masulani-Mwale et al. 2019). This PICO analysis underscores the need for government investment in training local stakeholders and community facilitators to deliver culturally competent, sustainable interventions that effectively enhance caregiver capabilities through improved knowledge, skills and psychological well-being, while promoting community ownership and addressing contextual factors that influence intervention outcomes (Trani et al. 2020).

Mental health interventions such as counselling, cognitive-behavioural therapy and psychotherapy addressed in (Studies 6, 10, 13, in Table 1) are crucial for psychological distress, caregiver burden and coping challenges faced by parents of children with disability in African communities, indirectly enabling better childcare (Keilty & Smith 2018; Caicedo 2016). Cultural adaptation through family-centred, collective decision-making involving extended families is significant. Integrating interventions with community support systems such as groups, faith organisations or traditional healers promotes culturally relevant, holistic, sustainable and acceptable care (Scherer et al. 2022).

Studies 11, 12, 15 and 17, in Table 1 highlighted the value of peer support groups, mentorship and connecting parents in similar circumstances, reducing isolation and sharing strategies (Guralnick 2019). Traditional support systems such as extended families, community elders and healers can provide vital, culturally grounded support. Integrating these systems into interventions can enhance acceptability and blend traditional and contemporary approaches seamlessly, which aligns with our review research question by addressing how culturally responsive healthcare interventions can effectively enhance caregiver capabilities through improved social support structures (Masulani-Mwale et al. 2019; Nyoni 2021).

Some studies (Studies 4, 8, 14 and 16, in Table 1) examined combined interventions, combining education, counselling, coaching and home visits, targeting diverse parental needs simultaneously (Masulani-Mwale et al. 2019). Integrated care models combining healthcare, social services and community support can holistically address caregivers’ multifaceted needs. Leveraging existing infrastructures and resources enables more effective, sustainable intervention delivery (Scherer et al. 2022).

Study 7 and 3 in Table 1 focused on interventions tailored to specific disabilities such as autism, addressing unique caregiver needs based on the child’s condition (Dababnah et al. 2021). These integrated community resources include culturally grounded peer support groups. The findings highlight the need for a range of supportive, tailored interventions to bolster diverse caregiver capabilities, which directly addresses our research question on effective healthcare interventions for enhancing caregiver well-being and skills (Lancaster et al. 2023; Riches et al. 2023).

Our systematic review offers significant insights into caregiver support interventions for children with DD, especially in resource-constrained countries such as South Africa. However, it is important to recognise certain methodological constraints. The expedited nature of our review process may have limited the depth of our analysis. By prioritising studies with quantifiable outcomes and modelling approaches, such as those by Sohmaran and Shorey (2019) who conducted a meta-analysis of stress reduction outcomes, Provenzi et al. (2021) who measured specific knowledge and skill improvements, and Lancaster et al. (2023) who quantified well-being improvements in peer support programmes, we might have inadvertently overlooked other valuable research paradigms. Our reliance on a select number of academic databases potentially excluded pertinent studies from alternative sources. Furthermore, our focus on English-language publications from 2014 onwards may have overlooked earlier relevant work or non-English contributions.

Notwithstanding these limitations, our findings underscore the importance of culturally tailored interventions and pinpoint crucial areas for policy development, practical implementation and further research. These results hold particular significance for caregivers in developing nations such as South Africa, where enhancing caregiver capability is a key objective of disability response strategies. This review lays the groundwork for crafting more effective and culturally sensitive interventions for parents of children with DD. To bolster the evidence base and inform more holistic approaches, we recommend additional research that addresses the limitations. This future work will be instrumental in refining and expanding our understanding of effective caregiver support in diverse global contexts.

The findings of our systematic review have several important implications for practice and policy. Firstly, they highlight the need for culturally adaptive interventions, suggesting that policymakers should prioritise the development and implementation of programmes that are sensitive to local contexts and traditions. Quantitative evidence from Masulani-Mwale et al. (2019) demonstrated high acceptability and practicability of culturally adapted interventions, while Provenzi et al. (2021) provided measurable outcomes showing significant increases in caregiver knowledge and skills when interventions were culturally tailored. Healthcare providers and social services should be trained in culturally competent care delivery. Secondly, the varied duration of effective interventions indicates that policy should support a range of short-term to long-term support options, allowing for personalised care plans. This is supported by the quantitative findings of Sohmaran and Shorey (2019), whose meta-analysis showed stress reduction immediately postintervention but not at 3–6 months follow-up, suggesting the need for ongoing support models. Thirdly, the success of peer support groups and community-based interventions suggests that policies should facilitate and fund such initiatives, potentially through community health worker programmes. Lancaster et al. (2023) provided robust quantitative evidence through their systematic review of 3,605 participants, showing measurable improvements in caregiver well-being through peer support programmes. Finally, the integration of traditional healing practices in some settings implies that policies should consider ways to respectfully incorporate these approaches into formal healthcare systems, where appropriate. By addressing these implications, policymakers and practitioners can work towards more effective, inclusive and sustainable support systems for caregivers of children with DDs.

Our systematic review of caregiver interventions for DD revealed mixed effectiveness across approaches. Recent studies (2018–2024) showed varied outcomes in psychological interventions. While Sohmaran and Shorey (2019) found short-term stress reduction, Provenzi et al. (2021) reported better behavioural change outcomes. Successful interventions featured personalised support and multidimensional approaches. Koly et al. (2021) documented improvements in parent and child interactions, while Lancaster et al. (2023) highlighted peer support benefits. Cultural context proved crucial, with Szlamka et al. (2022) emphasising flexible intervention models. Key facilitators included staff continuity and parent empowerment. Our review indicates a need for more comprehensive, culturally sensitive support strategies.