“If he has education, there will not be any problem”: Factors affecting access to education for children with disabilities in Tamil Nadu, India

functioning is reported on a scale of “no difficulty”, “some difficulty”, “a lot of difficulty” or “cannot do”. In line with international standards, disability was defined as experiencing “a lot of difficulty” or “cannot do” on at least one domain [28]. The census found a prevalence of childhood disability (5–18 years) of 1.0% in this population with significantly fewer children with disabilities enrolled in school compared to those without disabilities (57% vs 90%). Non- attendance of children with disabilities was more common among older children, children liv- ing in poorer households, or those who lived in Jawadhu Hills, a tribal community. Study design and recruitment In-depth interviews were conducted with caregivers and children with disabilities between the ages of 5–17 years from January–July 2020. The children were purposively selected from amongst the 299 children identified as having a disability during DeWorm3 project census to maximise heterogeneity by gender, age, and type and severity of functional limitations (“a lot of difficulty” or “cannot do”), and to have an equal balance of children in and out of school. Forty primary caregivers of children with disabilities were interviewed about their child’s expe- rience in school. They were approached by a member of the research team and if they agreed, an appointment was made for an interview at their home. Further, 20 of these children with disabilities (10 in school and 10 out of school) were selected to be interviewed directly. The pri-

mary caregivers were almost all family members, particularly mothers. Children selected to be interviewed directly were primarily older and able to communicate with available supports. Data collection and analysis Semi-structured interview guides were developed for caregiver and child interviews. The care- giver interview guides focused on, 1) family background; 2) child’s disability, health, and access to disability-related support services; and 3) child’s education, including reasons for non- attendance and/or their social and learning experience while at school. The children’s inter- views focused on the child’s “school journey”, exploring their experiences at home, getting to school, in the classroom, in the playground, and in using school facilities. Visual aids were used to prompt discussions, including emotion cards (faces with different expressions, such as “happy”, “sad”, and “angry”). Four interviewers received extensive training in the study proto- cols and disability. Interviews were conducted in Tamil, the local language, by experienced qualitative interviewers along with notetakers. All interviews were audio-recorded, transcribed verbatim, and translated into English. A codebook was developed using a priori codes based on the interview guides. A small number of additional codes were added inductively based on emerging findings. Each tran- script was coded independently by two researchers (one from each institution) using the code- book on ATLAS.ti 9.2 software. Coders had experience working on disability and education,

and/or on the context of Tamil Nadu. Coding decisions, including differences between coders, were discussed by the research team by video conferencing or over email and with a third researcher when consensus was not reached between primary coders. Except for authors involved in data collection, others did not have access to participants identifiable information. The mapping of codes into themes was decided jointly by the two research teams. The interre- lationships between themes and different participant characteristics (e.g., child’s gender, impairment type) were also examined. Ethics statement Ethical approval for this research was received from the Human Subjects Division at the Uni- versity of Washington (STUDY00000180) and the Institutional Review Board at Christian PLOS ONE Access to education for children with disabilities PLOS ONE | https://doi.org/10.1371/journal.pone.0290016 August 16, 2023 4 / 19