Mapping play-based interventions for children with disabilities in LMICs: a scoping review on cultural relevance, implementation, and impact.

Background: Over 90% of children with disabilities live in low- and middle-income countries (LMICs) and experience worse health outcomes than their peers. Play-based interventions may improve the well-being and quality of life of children with disabilities and their caregivers. We aimed to identify and map the evidence on play-based interventions for children with disabilities in LMICs. Methods: Following a systematic search of Medline, Embase, PsycINFO, African Journals Online, and LILACS, we screened 2577 studies for inclusion in October 2024. We used thematic analysis to summarise the data. Findings: Twenty eligible studies were identified that targeted children with disabilities, aged 2-12 years. Most studies (55%) focused on how play supports therapy, communication, and skills development, while fewer studies (15%) explored feasibility, developmental outcomes, or parental support. A substantial proportion of studies took place in upper-middle-income countries (60%) and 50% were from Central and South America. Many interventions were delivered by researchers (55%), with some involving parents (25%), community members (5%), or health professionals (10%). Cultural and contextual adaptations were noted in 40% of studies, and these changes were typically confined to surface features such as use of local languages, traditional games, and culturally relevant illustrations. While most studies reported positive outcomes, concerns were raised about limited parental engagement and challenges in adaptation. Only one study conducted a cost analysis. Ten grey literature resources met inclusion criteria. These resources offered practical guidance, mainly for caregivers and educators, on making play accessible for children with disabilities. Most emphasised play's role in development and inclusion, with 80% providing specific strategies, though none addressed cultural adaptation. Interpretation: Play-based interventions have the potential to enhance therapy, communication, and social inclusion, although gaps remain in understanding their feasibility and scalability. The lack of economic evaluations also limits the understanding of how these interventions can be implemented in low-resource settings. Our review highlights critical gaps in play-based interventions for children with disabilities in LMICs. Despite growing interest since the UNCRPD, play remains under-researched, with most studies being small-scale, short-term, and lacking cost analysis. Interventions rarely involved communities or addressed cultural relevance in depth. Future research should prioritise inclusive, community-driven, and culturally adapted approaches. Clearer documentation, economic evaluations, and rigorous methods are needed to ensure effective, scalable, and meaningful support. Promoting culturally grounded play can improve social inclusion, development, and dignity for children with disabilities. Funding: The scoping review was supported by the United Kingdom Medical Research Council (UKRI165) awarded to Prof Tracey Smythe in collaboration with the London School of Hygiene & Tropical Medicine.