Open Access

ARTICLE

Community-Based Rehabilitation for Developmental Delays in Rural Taiwan: A Mixed-Methods Evaluation of Intervention Outcomes and Implementation Challenges

Wei-Lin Wang¹, Wei-Sho Ho^2,3,4, Wei-Lun Huang^5,6,7, Shu-Jou Sun^8,*
1 Sanxia Disability Welfare Service Center, Eden Social Welfare Foundation, New Taipei City, Taiwan
2 Department of Electrical and Mechanical Technology, National Changhua University of Education, Bao-Shan Campus, Changhua City, Taiwan
3 Graduate Institute of Technological and Vocational Education, National Changhua University of Education, Bao-Shan Campus, Changhua City, Taiwan
4 NCUE Alumni Association, National Changhua University of Education, Jin-De Campus, Changhua City, Taiwan
5 Medical Affairs Office, National Taiwan University Hospital, Taipei City, Taiwan
6 Department of Health Services Administration, China Medical University, Taichung City, Taiwan
7 Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
8 Department of Special Education, National Tsing Hua University, Hsinchu City, Taiwan
* Corresponding Author: Shu-Jou Sun. Email:

International Journal of Mental Health Promotion https://doi.org/10.32604/ijmhp.2026.080856

Received 17 February 2026; Accepted 25 May 2026; Published online 27 July 2026

Abstract

Background: Equitable access to early childhood intervention (ECI) remains a persistent systemic challenge in under-resourced and rural communities, particularly for children with global developmental delay (GDD) and attention-deficit/hyperactivity disorder (ADHD). Community-based rehabilitation programs aim to reduce this disparity by delivering services in naturalistic environments, yet empirical evidence concerning their individualized effectiveness and implementation barriers in rural settings remains limited. Grounded in Bronfenbrenner’s bioecological systems theory and family-centered practice, this study aimed to evaluate the preliminary effectiveness and examine the implementation challenges of a community-based ECI program for children with developmental delays in rural Taiwan. Methods: A convergent mixed-methods design was employed. The quantitative phase used a single-case A-B-M (baseline, intervention, maintenance) design with three preschoolers; because the intervention was not withdrawn and reintroduced, the design is distinct from classical reversal (ABAB) withdrawal designs. Session-level target-behavior percentages were analyzed through visual analysis and complemented by the non-overlap of all pairs (NAP) and Tau-U effect-size estimates. The qualitative phase involved semi-structured interviews with eight key stakeholders—parents, special educators, therapists, social workers, and supervisors—analyzed through inductive thematic coding. Results: Visual analysis together with Tau-U indicated notable and sustained improvements in the three target behaviors (name writing, tripod pencil grasp, and same-different discrimination) for all three participants. Qualitative findings revealed multilevel implementation barriers, including caregivers’ limited awareness of ECI resources, inconsistent intergenerational parenting strategies, shortages of multidisciplinary professionals in rural catchments, and inflexible administrative procedures. Conclusions: These preliminary findings suggest that community-based rehabilitation is a promising model for supporting children with developmental delays in rural contexts, while highlighting that effectiveness is constrained by family-level and service-system barriers. Policymakers and practitioners should prioritize culturally responsive, parent-mediated training that engages co-resident grandparents, expand localized professional capacity, and streamline administrative communication.

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Keywords

Early childhood intervention (ECI); developmental delays; attention-deficit/hyperactivity disorder (ADHD); mixed-methods research; rural health disparities; single-case experimental design (SCED); Tau-U; parent-mediated intervention; community-based rehabilitation

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