Acceptance and Commitment Therapy in Reducing Compassion Fatigue Symptoms among Caregivers of Children with Physical Disabilities attending Selected Rehabilitation Clinics in Nairobi County, Kenya.

Abstract

Compassion fatigue, (CF) is common among caregivers of children with physical disabilities in low-resource settings. This study evaluated the effectiveness of Acceptance and Commitment Therapy (ACT) in reducing CF and associated negative mental health outcomes among caregivers in selected non-governmental rehabilitation clinics in Nairobi County, Kenya. Guided by the compassion fatigue resilience model, the social cognitive theory, and the transactional model of stress and coping, an explanatory sequential mixed-methods, quasi-experimental pre-/post-test control-group design was applied. A census of the accessible caregiver population at baseline (N≈140) was conducted, followed by purposive sampling of 70 caregivers meeting CF criteria into the quantitative phase (35 ACT, 35 control) and 15 for qualitative interviews. Outcomes were assessed using the Professional Quality of Life Scale (ProQOL), the Hospital Anxiety and Depression Scale (HADS), and the PTSD Checklist for DSM-5 (PCL-5). At baseline, CF was present in 89.3% of participants; probable PTSD affected 82.7%, and clinically significant anxiety and depression affected 78.0% and 74.7% respectively. Chi-square tests revealed no statistically significant associations between CF status and any socio-demographic variable (all p values > .05). At baseline, CF co-occurred with PTSD (82.7%), anxiety (76.7%), and depression (89.3%) among participants. Post-intervention, the ACT group showed a CF prevalence drop from 100% to 42.9% (McNemar p<.001), with mean ProQOL burnout and secondary traumatic stress scores reduced by 9.3 and 8.6 points, respectively (both p<.001), and compassion satisfaction increased by 6.8 points (p<.001). PTSD symptoms decreased by a mean of 14.2 points (p<.001) in the ACT group versus 2.3 points in controls (p=.178). HADS anxiety and depression scores fell by 3.9 and 4.1 points, respectively, in the ACT group (both p<.001), with smaller, non-significant changes in controls. Qualitative findings confirmed increased psychological flexibility, improved emotional regulation, and greater value-driven caregiving in the ACT group. ACT was, therefore, found to be a promising and culturally adaptable intervention for reducing CF, enhancing compassion satisfaction, and improving key mental health outcomes among caregivers in similar low-resource contexts. The study recommends integrating ACT interventions, enhancing caregiver support, training providers on CF management, and conducting longitudinal follow-ups.