Experiences of telehealth-delivered occupational performance coaching among Palestinian mothers of autistic children: a qualitative study.

Background: Families of autistic children in Palestine face substantial barriers to sustained, family-centred rehabilitation, including travel demands, fragmented services, financial pressures, digital inequalities, and recurrent movement restrictions. Occupational Performance Coaching (OPC) is a collaborative, occupation-focused approach that supports caregivers to analyse everyday participation challenges, identify priorities, generate contextually relevant strategies, and evaluate change. This study explored how Palestinian mothers experienced an eight-session OPC telecoaching intervention and how they perceived its acceptability, benefits, challenges, and contextual fit. Methods: A qualitative descriptive study was embedded within an explanatory sequential mixed-methods external pilot trial. All 12 mothers who completed OPC participated in a post-intervention semi-structured interview in Arabic via Zoom. The interview guide was informed by the Theoretical Framework of Acceptability (TFA) and included broader questions about intervention processes, perceived change, and contextual experience. Analysis of the complete Arabic interview dataset used reflexive thematic analysis. TFA provided deductive sensitizing concepts, while coding and theme development remained open to meanings arising from participants' accounts. Reflexive notes, cross-case comparison, attention to divergent accounts, peer debriefing, and an audit trail supported analytic reflexivity and transparency. COREQ guided reporting. Results: Five interrelated themes were developed: (1) from receiving advice to becoming a reflective problem-solver; (2) coaching in the context of everyday life; (3) taking responsibility: empowering, but demanding; (4) context-responsive access with conditional digital and cultural fit; and (5) meaningful progress as partial, variable, and still unfolding. Mothers valued collaborative reasoning, individualized goals, and the ability to work within real family routines. Remote delivery reduced some travel, scheduling, cost, and safety burdens, but connectivity, time, caregiving demands, and wider structural conditions remained important constraints. Increased parental responsibility could be experienced as both meaningful and demanding, and perceived changes were not uniform across goals or families. Conclusion: Mothers valued OPC telecoaching not only as a means of remote access, but as a way of working collaboratively on occupational challenges within everyday family life. Telehealth reduced selected access burdens in the Palestinian context but did not remove digital, caregiving, or structural constraints. The findings support further evaluation of culturally and contextually responsive, participation-focused telecoaching within pediatric occupational therapy.