An Ethnographic Study of a Play-Based Intervention for Visual-Motor Integration in Malawian Children with Albinism in Special School Settings

Children with albinism in Malawi often have visual impairments that affect visual-motor integration, impacting their engagement in education. Special schools typically have limited resources for specific interventions. Play-based approaches are not well studied within this cultural and resource-constrained setting. This study explored the implementation and perceived efficacy of a culturally adapted, play-based intervention to improve visual-motor integration for Malawian children with albinism attending special schools. An ethnographic study was conducted in two Malawian special schools. Data collection included prolonged participant observation of intervention sessions, semi-structured interviews with teachers and caregivers, and artefact analysis. Data were interpreted using thematic analysis. Three primary themes were identified: the essential role of teacher adaptation in making play activities accessible; observed increases in children’s engagement and task persistence; and significant social inclusion benefits occurring alongside skill development. A specific observation was that most participating children showed improved ability to track and reach for moving objects during ball games. The play-based intervention was a culturally acceptable and engaging approach for supporting visual-motor integration. Its perceived efficacy was closely linked to the contextual adaptations made by educators and the social learning environment it created. Occupational therapists should collaborate with special school teachers to adapt play materials for low vision. Interventions should integrate visual-motor goals within broader social participation activities. Future research should combine standardised visual-motor measures with qualitative methodologies. albinism, visual-motor integration, play-based intervention, ethnography, Malawi, special school, occupational therapy This study offers an in-depth, contextual understanding of implementing a play-based visual-motor integration intervention in a low-resource special education setting, underscoring the central role of cultural and pedagogical adaptation.