Received: 10 October 2023 | Accepted: 16 October 2024

DOI: 10.1002/cl2.70016

SYSTEMATIC REVIEWS
Disability

Effectiveness of interventions for improving educational

outcomes for people with disabilities in low‐ and
middle‐income countries: A systematic review

Xanthe Hunt1 | Ashrita Saran2 | Howard White3 | Hannah Kuper4

1
Department of Global Health, Institute for
Life Course Health Research, Stellenbosch Abstract
University, Cape Town, South Africa
Background: People with disabilities are consistently falling behind in educational out-
2
Campbell South Asia, New Delhi, India
comes compared to their peers without disabilities, whether measured in terms of school
3
Global Development Network, New Delhi,
India enrolment, school completion, mean years of schooling, or literacy levels. These
4
London School of Hygiene and Tropical inequalities in education contribute to people with disabilities being less likely to achieve
Medicine, International Centre for Evidence in employment, or earn as much if they are employed, as people without disabilities. Evi-
Disability, London, UK
dence suggests that the gap in educational attainment for people with and without
Correspondence disabilities is greatest in low‐ and middle‐income countries (LMICs). Exclusion of people
Xanthe Hunt, Department of Global Health,
with disabilities from mainstream education, and low rates of participation in education of
Institute for Life Course Health Research,
Stellenbosch University, Cape Town, South any kind, are important issues for global equity. Interventions which might have a positive
Africa.
impact include those that improve educational outcomes for people with disabilities,
Email: [email protected]
whether delivered in specialist or inclusive education settings. Such interventions involve
Funding information
a wide range of initiatives, from those focused on the individual level – such as teaching
Foreign, Commonwealth and Development
Office assistance to make mainstream classes more accessible to children with specific learning
needs – to those which address policy or advocacy.
Objectives: The objectives of this review were to answer the following research ques-
tions: (1) What is the nature of the interventions used to support education for people
with disabilities in LMICs? (2) What is the size and quality of the evidence base of the
effectiveness of interventions to improve educational outcomes for people with dis-
abilities in LMICs? (3) What works to improve educational outcomes for people with
disabilities in LMICs? (4) Which interventions appear to be most effective for different
types of disability? (5) What are the barriers and facilitators to the improvement of
educational outcomes for people with disabilities? (6) Is there evidence of cumulative
effects of interventions?
Search Methods: The search for studies followed two steps. Firstly, we conducted
an electronic search of databases and sector‐specific websites. Then, after initial
screening, we examined the reference lists of all identified reviews and screened the
cited studies for inclusion. We also conducted a forward search and an ancestral

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2025 The Author(s). Campbell Systematic Reviews published by John Wiley & Sons Ltd on behalf of The Campbell Collaboration.

Campbell Systematic Reviews. 2025;21:e70016. wileyonlinelibrary.com/journal/cl2 | 1 of 43

https://doi.org/10.1002/cl2.70016
2 of 43 | HUNT ET AL.

search. No restrictions in terms of date or format were placed on the search, but
only English‐language publications were eligible for inclusion.
Selection Criteria: In our review, we included studies on the basis that they were
able to detect intervention impact. Descriptive studies of various designs and
methodologies were not included. We also excluded any study with a sample size of
fewer than five participants. We included studies which examined the impact of
interventions for people with disabilities living in LMICs. There were no restrictions
on comparators/comparison groups in included studies. However, to be eligible for
inclusion, a study needed to have both an eligible intervention and an eligible out-
come. Any duration of follow‐up was eligible for inclusion.
Data Collection and Analysis: We used EppiReviewer for bibliographic management,
screening, coding, and data synthesis. Eligibility was assessed using a predesigned
form based on the inclusion criteria developed by the authors. We piloted all coding
sheets with at least five studies before use. The form allowed for coding of multiple
intervention domains and multiple outcomes domains. The entire screening process
was reported using a PRISMA flow chart. We screened all unique references from
our search title and abstract, with two independent reviewers determining rele-
vance, and repeated this process for full texts. Data was extracted from studies
according to a coding sheet. Coding included: (1) extraction of basic study char-
acteristics, (2) a narrative summary of procedures and findings (including recording
of iatrogenic effects), (3) a summary of findings/results table, (4) an assessment of
confidence in study findings, and (5) creation of a forest plot of effect sizes. A third
data collector, a research associate, checked the results of this process. Confidence
in study findings was assessed using a standardised tool. All coding categories were
not mutually exclusive and so multiple coding was done where an intervention
covered more than one category of intervention.
Main Results: Twenty‐eight studies were included in this review. Most studies
(n = 25) targeted children with disabilities. Only two studies directly targeted family
members, and the remaining three focused on service providers. Individuals with
intellectual or learning and developmental impairments were most frequently
targeted by interventions (n = 17). The category of interventions most represented
across studies was ‘Educational attainment support’, for instance, a reading com-
prehension intervention that combined strategy instruction (graphic organisers,
visual displays, mnemonic illustrations, computer exercises, predicting, inference,
text structure awareness, main idea identification, summarisation, and questioning)
for children with dyslexia. The second most common category of intervention was
‘Accessible learning environments’, for instance, programmes which aimed to
improve social skills or to reduce rates of victimisation of children with disabilities
in schools. Regarding intervention effects, included studies concerned with ‘Con-
ditions for inclusion of people with disabilities in education’ showed a moderately
significant effect, and one study concerned with teacher knowledge showed a
significant effect size. Among the 18 studies included in the analysis of interven-
tion effects on ‘Skills for learning’, 12 interventions had a significant effect. When
considering the effect of interventions on different outcomes, we see that the
HUNT ET AL. | 3 of 43

effect on literacy, cognitive skills, handwriting, and numeracy are significant. All
these effects are large but are based on a low number of studies. The studies
concerned with speech and school behaviour show no significant effect of inter-
vention. Across studies, heterogeneity is high, and risk of publication bias varies
but was frequently high. All but one study received an overall rating of low con-
fidence in study findings. However, this lack of confidence across studies was
largely due to the use of low‐rigour study designs and was not always reflective of
multiple points of weakness within a given study.
Authors' Conclusions: Children with disabilities fall behind in educational outcomes
as the current school systems are not set up to teach children with different
impairment types. There is no one ‘magic bullet’ intervention which can equalise
health outcomes for this group. A twin‐track approach is needed, which both ad-
dresses the specific needs of children with disabilities but also ensures that they are
included in mainstream activities (e.g., through improving the skills of teachers and
accessibility of the classroom). However, currently most interventions included in
this systematic review targeted individual children with disabilities in an attempt to
improve their functioning, skills, and competencies, but did not focus on main-
streaming these children into the school by system‐level or school‐level changes.
Consequently, a focus on evaluation of interventions which target not just the
individual with a disability but also their broader environment, are needed.

KEYWORDS
disability, education, inclusion, LMIC, school

1 | P L A IN LA N G U A G E S U M M A R Y contribute to people with disabilities being less likely to gain em-

ployment and earn as much as people without disabilities. The gap in
1.1 | Title educational attainment between people with and without disabilities
is largest in LMICs. There is an urgent need to address barriers to the
A range of individual‐level interventions work to improve educational inclusion of people with disabilities, and test approaches to improve
outcomes among people with disabilities in low‐ and middle‐income their access to and the success in formal and non‐formal educational
countries, but there is little research on systemic or school‐level programmes.
change.

1.4 | What is the aim of this review?

1.2 | The review in brief
For this Campbell systematic review, we wanted to analyse and then
A range of interventions work to improve educational outcomes summarise the findings from research studies that evaluated inter-
among people with disabilities, but these are mostly targeted at ventions to improve the educational outcomes of people with dis-
people with disabilities. More systemic approaches are needed to abilities in LMICs.
improve rates of access to, and likelihood of successful engagement
in, education.
1.5 | What are the main findings of this review?

1.3 | What is this review about? The review shares findings from a range of interventions and out-
comes that were identified across 28 studies. Most of the studies
People with disabilities often fall behind in education compared to included were aimed at children with disabilities, with a few tar-
their peers without disabilities. This is true for enrolment, retention, geting family members or service providers. People with intellectual
and completion of education. These inequalities in education or learning and developmental impairments were most frequently
4 of 43 | HUNT ET AL.

targeted by interventions. Eight of the included studies were from 1.7 | How up‐to‐date is this review?
India, four were from Iran, two were from China, two were from
South Africa and two were from Egypt. One study from each of the The review authors searched for studies up to March 2022. This
following countries was also included: Brazil, Jordan, Kenya, Leba- Campbell Systematic Review was published in _________.
non, Romania, Turkey, Malaysia, Nigeria, Uganda, and Zambia. Few
studies reported whether their setting was urban or rural. Most
commonly, interventions were delivered in classrooms in main- 2 | B A C K GRO U N D
stream or inclusive settings, followed by specialist school and
resource rooms of inclusive schools. 2.1 | The problem, condition, or issue
The category of interventions most commonly represented
across studies were those aimed at providing support for educational The main problem addressed by this review is that people with dis-
attainment, followed by those focused on improving the accessibility abilities are less likely to be enroled in school or to progress as well as
of learning environments. Educational attainment (including skills for their peers without disabilities. These inequalities in education con-
formal learning in schools and skills for life) was the most commonly tribute to people with disabilities being less likely to achieve em-
reported outcome. This was followed by more accessible learning ployment (Department of Economic and Social Affairs: Disability, no
environments, such as strengthened learning/social environment(s) date), or if they are employed, to earn as much as people without
and improved social inclusion. disabilities (Equality and Human Rights Commission, 2017).
All but one study received an overall rating of low confidence in Despite the lack of comparable data on education for people
study findings. However, low ratings were mostly due to the use of with disabilities, recent reports (UNESCO, 2020; World Bank,
low‐rigour study designs and was not always reflective of weakness 2019) showed that people with disabilities were consistently falling
in the actual study. Generally, methodological details were poorly behind in educational outcomes compared to their peers without
reported. disabilities, whether measured in terms of school enrolment, school
completion, mean years of schooling, or literacy levels. For
instance, UNESCO's 2020 Global Education Monitoring Report
1.6 | What do the findings of this review mean? (UNESCO, 2020) noted that children with disabilities make up 15%
of the out‐of‐school population, and that individuals with a sensory,
Many included interventions were effective at improving children's physical or intellectual disability are two and a half times more
functioning, skills, and competencies, but did not focus on institu- likely than non‐disabled individuals never to have been in school
tional (i.e., systemic or school‐level) changes. In terms of expanding (UNESCO, 2020).
the research evidence available, strong methodological procedures Evidence suggests that the gap between educational attainment
should be followed and reported on to allow for thorough assess- for people with and without disabilities is greatest in LMICs. In a
ment and comparisons across interventions. Where possible, inter- 2014 study, children with disabilities were found to be 5 to 10 times
ventions should be evaluated in terms of concrete outcomes like more likely to be excluded from school than children without dis-
school completion. Larger sample sizes that include and track out- abilities, and children with learning or communication impairments
comes for diverse demographic profiles would help to increase the were consistently among the least likely to attend school, particularly
rigour and reliability of findings, as would the use of standardised in Africa (Kuper et al., 2014). This finding has been supported by
measures. subsequent analyses; in 2018, a study by Mizunoya et al. (2018)
It is well established that a twin‐track approach is needed to showed that the disability gap in school attendance was statistically
improve inclusion and outcomes for people with disabilities, significant in all 15 LMICs the authors examined. In these settings,
meaning a focus both on targeting their specific needs but also living with a disability reduced the probability of being in school by a
ensuring they are included in mainstream activities. However, this median 30.9% (Mizunoya et al., 2018).
review showed that most included interventions tried to improve Importantly, Mizunoya et al. (2018) indicated that neither individual
children's functioning, skills, and competencies, but did not focus nor socio‐economic and household characteristics explained the scale of
on efforts for mainstreaming through institutional (i.e., systemic or the disability gap in education. This suggests that there is something in
school‐level) changes. There is a need for evaluation of interven- the environment of education – for instance, in the way schools are
tions which target not only the individual with a disability, but also structured and functioning, the way learning happens, the way teachers
ensure inclusion in their broader environment(s). Efforts should also and peers interact with children with disabilities, and other factors not
be made to integrate measures of disability within mainstream captured by demography – is keeping children with disabilities out of
education impact evaluations and other demographic/household school, and as such, unable to achieve positive educational outcomes.
surveys that include education outcomes, and existing non‐ Research from LMICs supports this assertion. For instance, evidence
targeted government programmes should evaluate whether they from Uganda suggests that barriers in the built environment at schools
are effective in improving educational outcomes for people with hinders inclusion (Wapling, 2016). Large class sizes (Hove, 2014;
disabilities. Wapling, 2016) and poor attitudes to educating children with disabilities
HUNT ET AL. | 5 of 43

by mainstream school educators (De Boer et al., 2011) are also reported children with certain types of impairments may benefit from sep-
to limit educational success among children with disabilities in LMICs. arate instruction where the environment and educators cater to
their specific learning needs. For instance, there are difficulties
with social integration, communication, and friendship for children
2.2 | Education for children with disabilities: who are Deaf but being educated in mainstream schools (Wolters
Specialist or inclusive? et al., 2011). These specific circumstances, as well as the slow pace
of transformation toward inclusive education in many countries,
There is an ongoing and important debate around different ap- means that it is important to consider both inclusive and specialist
proaches to providing education for children with disabilities: ‘main- school settings to fully account for the state of education for
streaming’ or inclusive education, versus ‘special needs’ or segregated people with disabilities.
education. Historically, when people with disabilities were granted In the context of a systematic review, inclusive education is a
access to education, that education mostly happened in so‐called thorny issue. Firstly, definitions of what passes as inclusive education
‘special’ schools (hereafter called specialist schools). These were differ widely. So‐called inclusive environments range from on the one
segregated learning environments where only children with dis- hand, settings where specialised services for children with disabilities
abilities were admitted, and where they would engage in learning simply do not exist, so these children are absorbed into mainstream
separately from children without disabilities. classrooms by default, to on the other hand, well‐resourced, inte-
In the past two decades, there has been a significant shift in this grated classrooms in which children with and without disabilities
status quo, with a movement from segregated to inclusive education participate fully in learning activities and are all provided the supports
which, in the school context, refers to the process of bringing chil- necessary. Secondly, there are numerous and varied models for im-
dren with or without special education needs together in the same plementing inclusive education.
premises and under the same conditions (Ghergut, 2012). In other These issues of clarity and definition mean that it can be hard for
words, learning environments where children with disabilities and a systematic review to draw meaningful connections and compari-
children without disabilities are educated together. The right to sons between different interventions, even when they are called
inclusive education was initially noted in the 1994 Salamanca ‘inclusive education interventions’. For the purposes of this review,
Statement and Framework for Action (UNESCO, 1994). However, it we define inclusive education broadly, according to the UNICEF (no
was the 2006 UN Convention on the Rights of Persons with Dis- date) definition:
abilities (UNCRPD) (UN General Assembly, 2007) which established
inclusive education as a legal right, mandating countries to support its Inclusive education means all children in the same
achievement. classrooms, in the same schools. It means real learning
Inclusive education requires that learning environments, which opportunities for groups who have traditionally been
previously catered only to relatively homogenous groups of students excluded.
who learned in similar ways, be adapted and resourced to allow the
full participation of all pupils, regardless of ability (Ghergut, 2012; As such, we considered both specialist and inclusive interven-
Stubbs, 2008). It implies contexts beyond school, and if followed tions that aimed to improve educational outcomes for people with
through to fruition, would see people with disabilities included in disabilities.
learning that begins at birth, is lifelong, and includes learning in the
home, the community, and in formal, informal and non‐formal situ-
ations (Stubbs, 2008). 2.3 | The significance of this review
Inclusive education, in light of the UNCRPD, is a key tenet of
education and/or disability policy in a number of countries The widespread exclusion of people with disabilities from main-
(Lindsay, 2007). Yet, the ideal of inclusive education in relation to stream education and their low rates of participation in education
disability is not without its limitations and complexities. In LMICs of any kind are important problems. First, people with disabilities
and poorly resourced contexts, in particular, the lack of experi- have a fundamental right to education. Both the UNCRPD and the
enced teachers, teaching aides in classrooms, high child‐to‐teacher United Nations Convention on Rights of the Child recognise the
ratios, and poor financing for inclusion can result in people with right of persons with disabilities to education and calls on signa-
disabilities being ‘housed’ in a mainstream school, but not truly tory states to facilitate their full and equal participation in edu-
experiencing or benefitting from inclusion in any meaningful way cation. This exclusion is also a development issue, as the Sus-
(Wapling, 2016). Even in well‐resourced settings, achieving the tainable Development Goals call for quality education for all, and
ideals of inclusive education is a human resource‐intensive un- include a target related to addressing inequitable access to edu-
dertaking, as teachers must address academic needs based on cation for people with disabilities. Additionally, there are multiple
individual ability. benefits to the inclusion of children with disabilities in schooling,
Further, while ‘special education’ has long been criticised as both in terms of social participation and for the improvement of
segregationist and discriminatory (Lipsky & Gartner, 1987), future employment prospects. Educational inclusion therefore
6 of 43 | HUNT ET AL.

creates positive outcomes for people with disabilities, both realm of disability and education to determine ‘what works’ to ensure
financial and non‐financial. There are also numerous benefits to educational inclusion and produce good educational outcomes for
including people with disabilities in lifelong learning, that is, edu- people with disabilities.
cation beyond the school years, including non‐formal education
and life skills education. Opportunities before school, such as early
childcare and education, are equally important for all individuals, 2.4 | A note on defining education
to support optimal childhood and lifelong development. The
review focusses on improving education outcomes for people with Many LMICs are postcolonial, non‐Western contexts. This raised an
disabilities. Early childhood development (ECD) to improve important issue for this review to address: ‘What do we mean by
development and prevent disability for children in general was education?’ In many LMICs, indigenous knowledge has historically
therefore not eligible. ECD targeted or including children with been and is still accorded a lower status than institutional knowledge.
disabilities, where results were reported separately for children For instance, low status may be accorded to the oral transmission of
with disabilities, would be eligible. intergenerational knowledge about which land is arable and which
To improve educational outcomes for people with disabilities, not, while high status is accorded to a university degree in agriculture.
barriers to inclusion need to be addressed. These barriers operate to The systematic review format privileges ‘Western’ positivist thought.
produce decreased rates of school attendance, poorer experiences in While we are willing to include studies which explore indigenous
school and lower educational outcomes. These barriers operate at the knowledge transfer in the context of disability, we are unlikely to find
level of the system (e.g., lack of policy), school (e.g., lack of accessible this information by examining published, written literature. As such,
infrastructure or skilled teachers), and the family/child (e.g., poor we note that the types of education and educational outcomes
health), as highlighted in UNESCO's 2020 Global Education Mon- privileged in this type of inquiry focus on those delivered through
itoring Report (UNESCO, 2020). The report notes, for instance, that formal institutions of learning (e.g., schools, universities, and voca-
policy and legislative barriers are prevalent, with laws in 25% of tional training centres), as opposed to other, less quantifiable forms of
countries (but over 40% in Asia and in Latin America and the knowledge transfer. This is a limitation of this review.
Caribbean) making provisions for education in separate settings, 10%
for integration and only 17% for inclusion of children with disabilities
in mainstream schools (UNESCO, 2020). 2.5 | The intervention
In response to these circumstances, education is considered a
core component in the WHO Community Based Rehabilitation (CBR) The interventions we considered in this review were those that sought
programme, a comprehensive and multi‐sectoral strategy aimed at to improve educational outcomes for people with disabilities, whether
equalising opportunities and including people with disabilities in all delivered in specialist or inclusive education settings. Such interven-
aspects of community life (WHO, 2010). CBR promotes the equal- tions involve a wide range of initiatives, from those focused on the
isation of opportunities between disabled people and people without individual level, such as teaching assistance to make mainstream
disabilities, and strives for the widespread inclusion of people with classes more accessible to children with specific learning needs, to
disabilities in all spheres of life (WHO, 2010). As such, the Guidelines those which are aimed at improving policies or advocacy strategies.
see education interventions as key to their multisectoral approach Garira (2020) proposes a unified conceptual framework for
(WHO, no date). Indeed, education is important for a vast number of quality education in schools. This framework (see Figure 1) highlights
social, environmental, economic, and human capital development the conditions required for quality education at various levels.
goals. CBR educational guidance documents note the global need to Various frameworks have been developed to support the edu-
expand and improve the quality, availability, accessibility, and equit- cational inclusion of and outcomes for people with disabilities
ability of education for children with disabilities (WHO, 2010). The (Adedeji & Campbell, 2013; Nazar et al., 2018; Vladimirova & Le
CBR programme also has an emphasis on early education, lifelong Blanc, 2016; Walid & Luetz, 2018). It is clear that high‐quality edu-
learning, and non‐formal education for people with disabilities. cation depends on people with disabilities being included into already
Although these international directives place obligations on high‐quality learning environments (Love & Horn, 2021). As such,
states to respect, protect, and fulfil the right to education of people improving the quality of global education is a necessary foundation
with disabilities, evidence on which interventions are actually effec- for high‐quality inclusive education. Garira's (2020) framework can
tive for achieving the outlined goals have not been established. thus also assist in conceptualising quality inclusive education.
Indeed, past evidence syntheses on the topic of education and dis- Taking a systemic approach to quality education, the unified
ability in LMICs have highlighted that very little literature has com- framework is based on an approach where inputs, processes, and
pared the educational outcomes of disabled people and their non‐ outputs can be specified at the national preschool, school, and ter-
disabled peers (Wapling, 2016). Furthermore, a majority of studies tiary levels (Garira, 2020). However, this review focuses on the latter
have focused on specialist school populations and did not address two, and omits ECD interventions.
questions of attendance or attainment (Maulik & Darmstadt, 2007). The interventions of interest in this review are described in
Consequently, there is a real need to evaluate interventions in the Table 1 below. For the purpose of this review, interventions were
HUNT ET AL. | 7 of 43

FIGURE 1 Garira's (2020) unified framework for quality education.

organised around the education pillar of the CBR matrix, although our and meaningfully participate in and benefit from, educational
taxonomy of interventions was refined based on pilot coding of opportunities; and
included papers. • National policies are comprehensive and facilitate inclusive
education.

2.6 | How the intervention might work These different categories of intervention can be conceived of in
clusters along a causal chain, that begins with accessible learning
Interventions which aim to improve educational outcomes for people environments.
with disabilities have a variety of foci (Table 1). They include ensur-
ing that:

• Learning environments, including schools, take in all children,

including children with disabilities;
• Learning environments, including schools, are inclusive and wel-
coming and that educators and peers are trained and supported to
create an inclusive space for learning by children with disabilities; The first set of interventions pertain to (a) addressing the
• Learning environments, including schools, have adequate infra- structural forces shaping the context in which education happens,
structure to be accessible to people with disabilities and provide and (b) improving the conditions of a learning environment to
accessible learning materials; better facilitate education for people with disabilities. Structural
• Skills for learning are strengthened for people with disabilities; interventions include those aiming to alleviate poverty, reduce
• People with disabilities are involved in education as role models, community‐wide stigma against people with disabilities, and/or
educators, policymakers, decision‐makers and contributors; improve the resources allocated to education at a national or
• The home environments of people with disabilities encourage and regional level. While many structural interventions do not mea-
support learning; sure educational outcomes, interventions which did measure
• Communities are aware that people with disabilities can learn; outcomes were eligible for inclusion in this review. This is
• Multisectoral collaboration between the health, education, social because altering the context in which education happens for
and other sectors is established and maintained; people with disabilities in ways that improve educational out-
• Rehabilitation and health services, and assistive technologies, are comes is technically an educational intervention. With respect to
available to learners with disabilities to ensure that they can fully the immediate conditions in which learning happen, modifications
8 of 43 | HUNT ET AL.

TABLE 1 Types of interventions to improve educational outcomes in people with disabilities.

Intervention domain Intervention sub‐category Description Example

Accessible learning Structural interventions Interventions that target aspects of the context Cash transfers to families of
environments in which education takes place, such as poverty children with disabilities
or poor resourcing of education

Learning social environment and Interventions to improve the quality and/or Teacher trainings on disability
social inclusion inclusiveness of learning social environments, awareness and attitudes
promote appreciation of diversity, and reduce
stigma and discrimination

Accessibility of built environment Interventions, including those centred on Developing inclusive information
and learning materials (including universal design, to improve physical technology infrastructure
universal design for learning) accessibility of educational spaces

Anti‐bullying policies and Interventions to prevent violence and bullying School‐wide anti‐bullying
programmes of students with disabilities, particularly young campaigns
women and girls

Educational services development Programmes and policy to provide for the Training of teachers in inclusive
capacity development of teachers (and in education practices
certain cases, parents) so that they can educate
learners with a wide range of learning needs

Inclusive education policies Policies that are developed and implemented in Implementation of inclusive
mainstream and special education settings to education policy
provide for quality education for people with
disabilities

Rehabilitation and health services, Interventions to make rehabilitation and health Provision of wheelchairs to children
and assistive technologies services and assistive technologies available to with physical disabilities who are of
learners with disabilities school‐going age

Educational attainment Skills for formal education/ Interventions to equip people with disabilities Early literacy and numeracy
support learning in schools with the skills necessary to pursue formal interventions
education, including school readiness

Skills for life Learning‐focused interventions to improve the Enhancement of attentional

life skills and living conditions of people with capacity or time management
disabilities

Education‐related quality of life Varied programmes that foster improved Psychosocial support for students
quality of life for learners with disabilities with disabilities

Attendance, enrolment, Formal enrolment Interventions to support the enrolment of Community‐based awareness
and completion support people with disabilities in formal education raising of need to enrol children
(inclusive or specialist) with disabilities in school

Non‐formal enrolment/ Interventions to support the enrolment of Community‐based awareness

participation people with disabilities in non‐formal education raising about opportunities for
education outside of school

School completion Interventions to support people with Tutoring for children with
disabilities in completing secondary and higher disabilities in final school year
education, and initiatives to facilitate the
acquisition of relevant qualifications by people
with disabilities (e.g., high school completion
certificates and training certificates)

Transition to higher levels of Interventions to support entry into post‐school University application support and
education opportunities on an equal basis with non‐ quotas for disabled students
disabled peers

Attendance Programmes to support attendance at school Cash transfers conditional on

among learners with disabilities child's school attendance
HUNT ET AL. | 9 of 43

to the school social environment and levels of social inclusion for At each phase of life, specific programmes for each of these
people with disabilities, accessibility of the built environment and levels of intervention can ensure that people with disabilities are
learning materials, educational services development and imple- included in mainstream education or have access to specialised
mentation and resourcing of inclusive education and anti‐bullying educational services when required or desired. These interventions
policies all contribute to conditions conducive to educational can also help to improve the quality of teaching and the accessibility
participation by people with disabilities. At this level of inter- of learning environments, and to assist disabled people in learning
vention, one would also expect to see that rehabilitation services, to the best of their ability. Throughout these stages, a supportive
health services, and assistive technologies are available to legal and policy environment is important, to mandate and monitor
learners with disabilities, to ensure that they are able to fully and inclusive education.
meaningfully participate in and benefit from educational Primary education, which begins at the age of 6 or 7 years
opportunities. and continues into the early teen years, is the pathway to

The second cluster of interventions which may improve educa- higher levels of education, and socialisation. It is therefore critical
tional outcomes among people with disabilities are those that aim to for achieving human development goals. Interventions for
equip people with disabilities with the skills necessary to engage in children with disabilities during this phase can help to create a
learning. These interventions include a broad range of initiatives in welcoming, inclusive primary education system where all children
the formal and non‐formal sectors, delivered to individuals of all ages, are able to fulfil their potential, achieve the best possible
which aim to equip disabled learners with skills for formal learning educational outcomes, and be well‐positioned to progress to
(e.g., learning in schools), school readiness, and broader life skills higher forms of education, should they choose. This can be
development. achieved through:

Once learning environments are made accessible, and people • Programmes to equip families to support their children's involve-
with disabilities are equipped with important skills for learning, it is ment in primary education;
important to deliver interventions aimed at improving attendance in • Initiatives aimed at improving the quality of inclusive or specialist
and completion of a variety of kinds of learning. This cluster of primary education;
interventions includes programming for increased participation by • Interventions aimed at ensuring that appropriate assistive devices,
and inclusion of disabled people in formal and non‐formal educa- therapies and other necessary assistance are accessible and
tional settings. Such interventions seek to improve school comple- available to support education;
tion and attendance among people with disabilities, given that • Training and education for teachers so that they feel supported and
successful educational attainment is predicated on educational are confident in their abilities to educate children with disabilities;
participation. • The development of curricula, examination and assessment sys-
The final cluster of interventions are those which aim to equip tems, teaching approaches, and extracurricular activities which are
people with disabilities with qualifications or improve the throughput appropriate for children with disabilities;
rates of people with disabilities at various stages of education, those • The development of local resources for education, including
seeking to improve the education‐related quality of life of disabled accessible learning materials; and
students, and interventions aimed at supporting transitions between • Projects which establish and maintain partnerships between rele-
different levels of education. vant stakeholders and involve advocacy at all levels, to ensure that
10 of 43 | HUNT ET AL.

national policies promote primary education for children with education, ensuring that educational opportunities are inclusive,
disabilities (World Health Organization, 2010). making reasonable accommodations for people with disabilities, and
providing specialised supports where necessary. Target outcomes
Secondary and higher education includes both high school and relate to improving environmental conditions, access, attendance,
university academic programmes, as well as a variety of technical and and achievement in education.
vocational educational opportunities. Interventions to support the
inclusion of people with disabilities, and their achievement of the best
possible educational outcomes, in these levels of education centre on 2.7 | Why it is important to do this review
increasing and improving access, participation and achievement for
students with disabilities, and ensuring that learning environments International directives place firm obligations on states to respect,
are inclusive. Interventions can achieve these aims through: protect, and fulfil the right to education for people with disabilities, as
described above. However, evidence on which interventions are
• Increasing enrolment and retention in and completion of inclusive or effective to achieve the goals they outline have not been established
specialist secondary and higher education by students with disabilities; or comprehensively reviewed.
• Helping students with disabilities to access government grants, Several relevant Cochrane and Campbell systematic reviews and
scholarships and other sources of supportive funding; protocols exist that are relevant to the topic, but none which address the
• Ensuring that advocacy groups and campaigns for equal access to objectives of this review. For instance, in the Cochrane database, one
education exist and are well‐resourced; review (Pennington et al., 2018) assessed the effectiveness of parent‐
• Supporting families and communities to encourage their children mediated communication interventions for improving the communication
with disabilities to pursue secondary and higher education; skills of preschool children (up to 5 years of age) who have non‐
• Making sure that secondary and higher education programmes are progressive motor disorders. Also from Cochrane, another review (Cogo‐
accessible and inclusive in terms of environment, teaching meth- Moreira et al., 2012) considered the evidence on music education as a
ods and materials, curricula, extracurricular activities, and assess- means for improving reading skills in children and adolescents with dys-
ment and examination systems; lexia. A further Cochrane review has been undertaken on task‐oriented
• Promoting learning about diversity and inclusion based on the interventions for children with developmental co‐ordination disorder
experiences of (and ideally communicated by) people with dis- (Miyahara et al., 2017). In all cases, however, the scope of these reviews is
abilities in secondary schools; significantly narrower than our review. In each of these reviews, for ex-
• Providing specialist resources and support to enhance inclusion for ample, the focus is on children with particular conditions (i.e., non‐
students with disabilities; and progressive motor disorders, dyslexia and developmental co‐ordination
• Supporting transitions between secondary or higher education disorder only) and the type of intervention and outcome are limited
programmes into adult life (World Health Organization, 2010). (parent‐mediated interventions, music interventions and task‐oriented
interventions only; communication and reading skills only).
Finally, other ‘untraditional’ initiatives for learning, such as non‐ Other rigorous but topic‐specific reviews have been conducted and
formal education (sometimes called community education), adult edu- reported in the peer‐reviewed literature (Buysse & Bailey, 1993; Elbaum
cation and lifelong education are also valuable and are not necessarily et al., 1999; Forlin et al., 2013; Gersten et al., 2001; Hudson et al., 2013;
based in schools or institutions. Such types of education include home‐ Katz & Mirenda, 2002; Paradise et al., 2009; Pierce et al., 2004; Purdie
based learning, government schemes and other local programmes et al., 2002; Reichrath et al., 2010; Ruijs & Peetsma, 2009; Trout
aimed at improving the knowledge and skills of community members. et al., 2003; Wapling, 2016). In one case (Reichrath et al., 2010), inter-
Interventions to improve access to non‐formal education and improve ventions in general education for students with disabilities are considered.
educational outcomes for people with disabilities may focus on: However, all of the above reviews are limited in respect of the:

• Making sure that non‐formal education programmes include • Geography of research represented, with none being specifically
people with disabilities and consider their needs during pro- focused on LMICs;
gramme planning; • Type of review (e.g., non‐systematic, narrative, scoping or reviews
• Actively involving people with disabilities, their family members, of reviews) (review type not specified – Forlin et al. (2013);
disabled people's organisations and parents' associations in decision‐ Wapling (2016));
making and implementing non‐formal education programmes; and • Impairment type or disabling condition considered [emotional and
• Strengthening social cohesion between students with disabilities behavioural disorders only – Trout et al. (2003), Pierce et al.
and non‐disabled students (World Health Organization, 2010). (2004); ADHD only – Purdie et al. (2002); Alzheimer's only
Paradise et al. (2009)];
Intervention efforts at each of the abovementioned stages of • Eligible outcomes included [reading only – Elbaum et al. (1999),
education aim to improve the educational outcomes of people with Gersten et al. (2001); development and behaviour only – Buysse
disabilities through, among other strategies, improving access to and Bailey (1993); academic outcomes only – (Pierce et al., 2004)];
HUNT ET AL. | 11 of 43

• Other socio‐demographic restrictions, such as location or age of the (a) included random allocation of participants;
target population [both children with and without disabilities – Ruijs (b) used a quasi‐random method of participant allocation;
and Peetsma (2009); Western contexts only Reichrath et al. (2010)]; (c) allocated participants according to matched pre‐test and/or
• Interventions included [inclusive education only – Wapling (2016); relevant demographic characteristics (using observables or
Forlin et al. (2013); Katz and Mirenda (2002); Ruijs and Peetsma propensity scores) and/or a cut‐off on an ordinal or contin-
(2009); teacher‐mediated interventions only – Pierce et al. (2004)]; uous variable (such as in regression discontinuity study
and/or designs);
• Out of date Buysse and Bailey (1993); Elbaum et al. (1999); Trout (d) used statistical methods to control for differences between
et al. (2003). participant groups which existed at baseline (for instance,
where multiple regression analysis or instrumental variables
Finally, White et al. (2018) recently conducted an evidence gap regression is used), rather than participants being randomly
map (EGM) on educational interventions for people with disabilities in assigned;
LMICs. An EGM can be distinguished from a review in that an EGM is (e) used an interrupted time‐series design, with attempts to
used to identify, map and describe existing evidence of effectiveness, detect whether the intervention had an effect which was
highlight gaps in an evidence base, and sometimes, inform a subse- significantly greater than any underlying trend which would
quent systematic review. White et al.'s (2018) EGM discussed impact have occurred without intervention over time, using obser-
evaluations and systematic reviews that assessed the effects of vations at multiple time points before and after the
interventions for people with disabilities and their families or carers in intervention;
LMICs and included 46 studies related to education outcomes. Many (f) used historical controls, with participants who were receiving an
– but not all – of the same studies were eligible for inclusion in this intervention being compared to a similar group from the past
review, but this review covers an extended time frame compared to who had not received the same intervention; and
the EGM. (g) used a single‐group before‐and‐after design, with observations
being made on a group of individuals before and after an inter-
vention, but with no control group.
3 | OBJECTIVES
Descriptive studies of various designs and methodologies (such
The objectives of this review were to answer the following research as qualitative interview studies, single time‐point cross‐sectional
questions: surveys, etc.) were not included. We also excluded any study with a
sample size of fewer than five participants.
1. What are the characteristics of interventions aimed at supporting
education for individuals with disabilities in LMICs?
2. What is the size and quality of the evidence base of the effec- 4.1.2 | Types of participants
tiveness of interventions to improve educational outcomes for
people with disabilities in LMICs? We included studies which examined the impact of interventions
3. What works to improve educational outcomes for people with for people with disabilities living in LMICs. Population subgroups
disabilities in LMICs? of interest included: women with disabilities, children with dis-
4. Which educational interventions appear most effective for differ- abilities (particularly vulnerable children with disabilities), people
ent types of disabilities are conducted as standalone interventions? with different impairments, people with disabilities living in
conflict and post‐conflict settings, migrants with disabilities,
refugees and internally displaced people with disabilities,
4 | M E TH O D S and ethnic minorities with disabilities. All impairment types were
eligible, including physical, mental, intellectual, and sensory
The protocol for this review was registered by the authors in 2021 impairments.
(Hunt et al., 2021).

4.1.3 | Types of interventions

4.1 | Criteria for considering studies for this review
There were no restrictions on comparators or comparison
4.1.1 | Types of studies groups in the studies that were included. However, to be eligible
for inclusion, a study had to have both an eligible intervention and
In our review, we included studies on the basis that they were able to an eligible outcome. Eligible interventions were detailed in
detect intervention impact. This included studies which: Table 1.
12 of 43 | HUNT ET AL.

4.1.4 | Types of outcomes and outcome measures outcome, rather than in this review. For a lifelong learning inter-
vention to be eligible for inclusion in this review, it had to have
Eligible outcomes, as for interventions, were largely based on the education outcomes other than employment or participation in the
education pillar of the CBR matrix, as shown in Table 2 below, which labour market.
details the outcomes of interest. All outcomes were considered
eligible, regardless of whether they were primary or secondary
outcomes of the impact evaluation. The authors of this review have 4.1.5 | Duration of follow‐up
recently undertaken a systematic review of interventions to
improve livelihoods among people with disabilities in LMICs. Any duration of follow‐up was eligible for inclusion, and studies were
Vocational training programmes were included in that review, coded to analyse the ‘impact trajectory’, that is, how effects varied
where employment/engagement in the labour market was the only over time.

TABLE 2 Outcome categories and sub‐categories.

Outcome domain Outcome sub‐category Description Example outcome

Accessible learning Strengthened learning Learning social environments are inclusive, stigma and Improved school climate
environments environment and discrimination decrease, and people with disabilities are
improved social inclusion included socially

Improved accessibility of Classrooms and educational establishments are physically Improved accessibility audit
built environment and accessible to learners with disabilities, and learning materials scores
learning materials are accessible

Reduced rates of bullying Anti‐bullying and anti‐violence interventions are adequately Reduced rates of violence
and victimisation in resourced and implemented, and result in reductions in rates
education setting of bullying and violence

Educational services Teachers, and in some cases parents, acquire appropriate skills Improved teacher
developed to educate learners who have a wide range of learning needs knowledge, attitudes, and
practices regarding disability

Provision and utilisation People with disabilities have access to the necessary Increased access to assistive
of rehabilitation and rehabilitation and health services and assistive technologies devices
health services, and necessary to enable their full participation in education
assistive technologies

Educational attainment Skills for formal People with disabilities acquire skills which are necessary Higher scores on
education/learning in precursors to success in formal education, including improved standardised scholastic tests
schools school readiness

Skills for life People with disabilities make use of youth or adult centred Improved capacity for
learning opportunities to improve their life skills and living attention
conditions, including through the acquisition of skills for
self‐care, self‐management, and integration

Education‐related quality Learners with disabilities experience educational opportunities Improved education‐related
of life as positive, and as contributing to a good quality of life quality of life

Attendance, Formal non‐formal People with disabilities have resources and support to enrol in School enrolment rate
enrolment, and quality secondary and higher education in an enabling and increases among disabled
completion supportive environment, and people with disabilities children
experience equal opportunities to participate in learning
opportunities that meet their needs and respect their rights

Non‐formal enrolment/ People with disabilities participate in a variety of non‐formal Improved vocational training
participation learning opportunities based on their needs and desires enrolment rates for disabled
youth

School completion People with disabilities have the resources and support to Qualifications gained
complete quality secondary and higher education in an
enabling environment

Attendance People with disabilities attend secondary and higher education Improved attendance rates

Transition to higher levels People with disabilities have access to post‐school options on Increased university
of education an equal basis with their peers enrolment rate
HUNT ET AL. | 13 of 43

4.1.6 | Types of settings 4.2.1 | Electronic searches

All studies needed to originate from an LMIC, as defined by the We searched the following electronic databases:
World Bank. Within these regions, any intervention setting was eli-
gible (e.g., school, home, community). • CINAHL.
• ERIC.
• Scopus.
4.2 | Search methods for identification of studies • Web of Science (Social Sciences Citation Index).
• WHO Global Health Index.
This systematic review was based on an update of searches con- • MEDLINE(R).
ducted for an EGM that presented findings on the effectiveness of • Embase Classic + Embase.
interventions for people with disabilities in LMICs (Saran et al., 2020). • PsycINFO.
The EGM was commissioned by the United Kingdom's Foreign, • CAB Global Health.
Commonwealth & Development Office (FCDO), under its support for
the Centre for Excellence for Development Impact and Learning MEDLINE, Embase, PsychINFO, and CAB Global Health were
(CEDIL) and the PENDA grant from DFID. For this review, we up- searched through OVID, and ERIC and CINAHL through Ebsco.
dated the database search and screened references to identify PubMED was searched through NCBI. We tailored the search strategy
additional studies. This review was based on the updated searches for each of the databases (see Annex S1A), but the main search strategy
performed for the EGM in February 2020. The EGM found that with included the following populations, study designs and location terms:
regard to education, few studies reported on the participation of Population. (disable* or disabilit* or handicapped) OR (physical*
children with disabilities in formal education. The most commonly or intellectual* or learning or psychiatric* or sensory or motor or
reported education outcome in their EGM was ‘social and life skills neuromotor or cognitive or mental* or developmental or communi-
development’ with effects reported from health interventions (reha- cation or learning) OR (cognitive* or learning or mobility or sensory or
bilitation and promotion), as well as early child development, and visual* or vision or sight or hearing or physical* or mental* or intel-
non‐formal education. Our findings differed in this respect, but this lectual*) adj2 (impair* or disabilit* or disabl* or handicap*) OR (com-
difference is largely due to the inclusion and exclusion criteria em- munication or language or speech or learning) adj5 (disorder*) OR
ployed in our systematic review as compared to the EGM. We ex- (depression or depressive or anxiety or psychiat* or well‐being or
cluded certain studies where the intervention and outcomes lacked a quality of life or self‐esteem or self‐perception) adj2 (impair* or dis-
clear education focus, and so the rehabilitation interventions and abilit* or disabl* or handicap*) OR mental health OR (schizophreni* or
social skills development outcomes included under education in psychos* or psychotic or schizoaffective or schizophreniform or
Saran et al.'s EGM were excluded here and are instead dealt with in dementia* or alzheimer*) adj2 (impair* or disabilit* or disabl* or
two other systematic reviews on health outcomes and social inclusion handicap*) OR (mental* or emotional* or psychiatric or neurologic*)
outcomes respectively, also by our team. The EGM also did not find adj2 (disorder* or ill or illness*) OR (autis* or dyslexi* or Down*
many studies conducted with primary and secondary school‐aged syndrome or mongolism or trisomy 21) OR (intellectual* or educa-
participants, which we have included in this review. Again, this is due tional* or mental* or psychological* or developmental) adj5 (impair*
to different inclusion criteria, partly because the EGM included or retard* or deficien* or disable* or disabili* or handicap* or ill*) OR
vocational training with livelihoods outcomes while this review (hearing or acoustic or ear*) adj5 (loss* or impair* or deficien* or
did not. disable* or disabili* or handicap* or deaf*) OR (visual* or vision or
The search for studies followed three steps. eye* or ocular) adj5 (loss* or impair* or deficien* or disable* or dis-
abili* or handicap* or blind*) OR (cerebral pals* or spina bifida or
o First, an electronic search of databases and sector‐specific web- muscular dystroph* or arthriti* or osteogenesis imperfecta or mus-
sites was conducted which was done for the EGM describes culoskeletal abnormalit* or musculo‐skeletal abnormalit* or muscular
above. The list of databases and search term used for the search abnormalit* or skeletal abnormalit* or limb abnormalit* or brain injur*
to update the EGM is described below. or amput* or clubfoot or polio* or paraplegi* or paralys* or paralyz* or
o Open Alex Search: We then utilised eligible studies from the hemiplegi* or stroke* or cerebrovascular accident*) adj2 (impair* or
updated EGM that were part of the education review. This led us disabilit* or disabl* or handicap*) OR (physical* adj5 (impair* or de-
to conduct an Open Alex search within the EPPI (Evidence for ficien* or disable* or disabili* or handicap*) OR people with dis-
Policy and Practice Information and Coordinating Centre) data- abilities/or children with disabilities/or people with mental dis-
base, specifically targeting studies published from 2020 to 2022. abilities/or people with physical disabilities/OR abnormalities/or exp
o Grey Literature Search: To ensure a thorough review, we also congenital abnormalities/or exp deformities/or exp disabilities/or exp
performed searches for grey literature to complement the findings malformations/OR exp mental disorders/or exp mental health/or
from the Open Alex search for the period between 2020 learning disabilities/or paralysis/or paraparesis/or paraplegia/or
and 2022. poliomyelitis/or hearing impairment/or deafness/or people with
14 of 43 | HUNT ET AL.

hearing impairment/or vision disorders/or blindness/or people with literature, so as to minimise the risk of publication bias in our review.
visual impairment/. To this end, we searched the following websites and databases using
Study design. (systematic* or synthes*) adj3 (research or eva- a tailored keyword search for grey literature (for full list contact
luation* or finding* or thematic* or report or descriptive or ex- authors):
planatory or narrative or meta* or review* or data or literature or
studies or evidence or map or quantitative or study or studies or • International Labour Organisation.
paper or impact or impacts or effect* or compar*) OR (meta regres- • Department for International Development (DfID), including
sion or meta synth* or meta‐synth* or meta analy* or metaanaly* or Research for Development (R4D).
meta‐analy* or metanaly* or metaregression or metaregression or • United Nations Educational, Scientific and Cultural Organisation.
methodologic* overview or pool* analys* or pool* data or quantita- • World Health Organization.
tive* overview or research integration) OR (review adj3 (effectiveness • Disability Programme of the United Nations Economic and Social
or effects or systemat* or synth* or integrat* or map* or methodo- Commission for Asia and the Pacific.
logic* or quantitative or evidence or literature)) OR (meta ethno- • United States Agency for International Development.
graph* or meta synthesis or (synthesis and (qualitative literature or • Dissertation Abstracts, Conference Proceedings and Open Grey.
qualitative research)) or critical interpretive synthesis or (systematic • Humanity and Inclusion.
review and (qualitative research or qualitative literature or qualitative • CBM.
stud*)) or thematic synthesis or framework synthesis or realist review • Sightsavers.
or realist synthesis or qualitative systematic review* or qualitative • Plan International.
evidence synthes* or ((quality assessment or critical appraisal or lit-
erature search*) and (qualitative research or qualitative literature or
qualitative stud*)) or (Noblit and Hare) or meta narrative* or narrative 4.3 | Data collection and analysis
synthesis) OR meta‐analysis/or evaluation studies/or qualitative
research/or systematic review/OR controlled clinical trial/or ran- 4.3.1 | Description of methods used in primary
domized controlled trial/or equivalence trial/or pragmatic clinical research
trial/or case‐control studies/or retrospective studies/or cohort
studies/or follow‐up studies/or longitudinal studies/or prospective We used EppiReviewer for bibliographic management, screening,
studies/or epidemiologic methods/or epidemiologic studies/or con- coding, and data synthesis. Eligibility was assessed the inclusion
trolled before‐after studies/or cross‐sectional studies/or interrupted criteria based on PICOS framework as described in detail in the
time series analysis/or control groups/or cross‐over studies/or previous section. This form was developed by XH and AS and was
double‐blind method/or matched‐pair analysis/or meta‐analysis as reviewed by HK and HW. We piloted all coding sheets with at least
topic/or random allocation/or single‐blind method/or retraction of five studies before use. The form allowed for coding of multiple
publication/or case reports/OR (random or placebo or single blind or intervention domains and multiple outcome domains. Articles ex-
double blind or triple blind or cohort or ((case or cohort or follow up cluded at this stage are summarised in the subsection ‘Excluded
or follow‐up) adj2 (control or series or report or study or studies)) or Studies’ below. The entire screening process was reported using a
retrospective or (observ adj3 (study or studies))). PRISMA flow chart (see Figure 2 below).
Location. Developing Countries OR Africa/or Asia/or Caribbean/
or West Indies/or Middle East/or South America/or Latin America/or
Central America/OR (Africa or Asia or Caribbean or West Indies or 4.3.2 | Criteria for determination of independent
Middle East or South America or Latin America or Central America) findings
OR ((developing or less* developed or under developed or under-
developed or middle income or low* income or underserved or under We did not find multiple publications reporting on the same study.
served or deprived or poor*) adj (countr* or nation? or population? or
world or state*)) OR ((developing or less* developed or under deve-
loped or underdeveloped or middle income or low* income) adj 4.3.3 | Selection of studies
(economy or economies)) OR (low* adj (gdp or gnp or gross domestic
or gross national)) OR (low adj3 middle adj3 countr*) OR (lmic or lmics We screened all unique references from our search of titles and
or third world or lami countr*) OR transitional countr*. abstracts. Two independent reviewers determined relevance. If any
disagreement arose, it was resolved by HW and HK. A similar pro-
cess was followed for full texts: the full text of articles which
4.2.2 | Searching other resources appeared relevant based on title and abstract were screened inde-
pendently by two independent reviewers, with disagreements
As noted, we searched the reference lists of identified recent papers resolved by HW and HK. Reviewers demonstrated an 86% rate of
and reviews. We also ensured that we covered the unpublished agreement.
HUNT ET AL. | 15 of 43

FIGURE 2 PRISMA flow chart of study screening and selection process.

4.3.4 | Data extraction and management types of impairments covered. Where appropriate and possible, we
extracted the following methodological and quantitative data:
XH and AS worked independently to code the included studies. They
extracted data from the studies according to a coding sheet • Study design.
(Annex S1B). A third data collector, a research associate, checked the • Analysis method.
results of this process. Studies were coded by intervention, outcome • Type of comparison (if relevant).
(s) and a range of filters (such as age of target population), as well as • External validity.
16 of 43 | HUNT ET AL.

• Outcome descriptive information. they are measured, preferably with reference to a widely used
• Sample size in each intervention group. international standard.
• Outcomes means and standard deviations. 6. Baseline balance: This shows that the treatment and comparison
• Test statistics (e.g., t‐test, F‐test, p‐values, 95% confidence inter- groups are the same at baseline. Lack of balance between groups
vals [CIs]). at baseline can bias the results.
• Information on intervention design.
• Confidence in study findings. Confidence in study findings was rated as high, medium, or low,
for each of the criteria, based on application of these standards.
As noted, where systematic reviews were discovered by our Overall confidence in study findings was the lowest rating a study
searches, their reference lists of primary studies were also assessed achieved across the criteria (e.g., a study receiving low for any criteria
for eligibility – we have not included summarised findings of the would receive an overall rating of low).
systematic reviews in this review.

4.3.6 | Measures of treatment effect

4.3.5 | Confidence in study findings in included
studies Effect size estimates with 95% CIs) were extracted from included
studies. Effect sizes were measured as SMDs with their 95% CIs. In all
1
Table 3 presents the tool we used to assess confidence in study studies, treatment effects were reported as continuous outcomes.
findings. This tool, which the authors are using across a range of Treatment effects were estimated using SMDs for RCTs and quasi‐
disability intervention systematic reviews, contains six criteria: experiments with two independent groups by entering the required
data into metafor package in R (M, SD, n). SMDs were calculated
1. Study design: Potential confounders must be considered in using baseline‐adjusted mean differences (i.e., mean change scores) in
assessing the impact of an intervention. Reliable impact evalua- studies reporting baseline and post‐intervention outcome data. The
tions should have either a well‐designed control group, preferably formulae for these effect sizes are presented in other Campbell
based on random assignment, or an estimation technique which review protocols (Sharma Waddington & Cairncross, 2021).
controlled for confounding and the associated possibility of
selection bias.
2. Masking: Masking, or blinding, is only relevant in randomised 4.3.7 | Unit of analysis issues
controlled trials (RCTs). This procedure helps to limit the biases
which can occur if study participants, data collectors or data The unit of analysis of interest to the present review was individual
analysts are aware of the assignment condition of individual people with disabilities, their caregivers, carers, or those working with
participants. them. If a study had more than two intervention arms, we included
3. Attrition: This can be a major source of bias in studies, especially only intervention and control groups that met the eligibility criteria.
if there is differential attrition between the treatment and Where multi‐arm studies were included, we ensured not to double‐
comparison group so that the two may no longer be balanced in count participants and separately reported eligible interventions and
pre‐intervention characteristics. We applied the standards for their respective outcomes. No subgroup analyses were conducted.
acceptable levels of aggregate and differential levels of
attrition, according to a set of standards developed by the
United States Institute of Education Sciences What Works 4.3.8 | Dealing with missing data
Clearing House.2
4. Clear definition of disability: For a study to be useful, the study No included study was eliminated from the analysis due to miss-
population must be clear, which means that the type and degree ing data.
of disability should be clearly defined, preferably with reference to
a widely used international standard.
5. Clear definition of outcome measures: To aid interpretation and 4.3.9 | Assessment of reporting biases
reliability of findings and comparability with other studies, out-
come measures must be clearly defined. Studies should state the Publication bias was assessed visually with funnel plots produced
outcomes being used with a definition and the basis on which using the metafor package in R and tested more formally with Egger's
meta‐regression test (Egger et al., 1997). A funnel plot involves
plotting the effect size (horizontal axis) against the study's precision
1
Thanks to Hugh Waddington (3ie and Campbell IDCG) for their suggestions, which were (vertical axis). There should be a symmetric distribution of effect sizes
used in developing the tool.
2 between the different studies without publication bias (the vertical
See Table 1 of the standards of the United States Institute of Education Sciences What
Works Clearing House. line in the centre). In theory, studies with a low degree of precision (at
 HUNT
ET AL.

TABLE 3 Study quality assessment criteria.

Criterion Low Medium High

1 Study design (potential Before versus after; naïve matching Instrumental variables (IV) estimation, regression RCT, natural experiment
confounders considered) discontinuity design (RDD), propensity score matching
(PSM), double difference

2 Masking (RCTs only) No mention of masking Masking for analysis Masking of data collection (where feasible);
masking for analysis

3 Losses to follow up are presented Attrition not reported OR falls well outside What Overall and differential attrition close to WWC Overall and differential attrition within
and acceptable Works Clearing House (WWC) acceptable combined combined levels WWC combined levels
levels OR overall attrition >50%

4 Disability/impairment measure is No definition Unclear definition OR Single question item only Clear definition, for example, Washington
clearly defined and reliable Group questions, detailed measure of
impairment

5 Outcome measures are clearly No definition Unclear definition OR Single question item only Clear definition using existing measure
defined and reliable where possible

6 Baseline balance (N/A for No baseline balance test (except RCTs) OR reported Baseline balance test, imbalance on 5 or fewer RCT, RDD
uncontrolled before vs. after) and significant differences on more than five measures
measures; PSM without establishing common support

7 Overall confidence in study Low on any item Medium or high confidence on all items RCT with high confidence on all items
findings
|
17 of 43
18 of 43 | HUNT ET AL.

the bottom of the graph) will deviate more from the pooled effect 18,842 due to irrelevance to the review, leaving 3559 articles for
size than studies with a high degree of precision (at the top of the full paper review and to determine inclusion in the review. Of
graph), creating a funnel distribution. An asymmetric funnel plot these 3559, a further 3395 were excluded, and 164 new studies
suggests publication bias (Deeks et al., 2005). Egger's test involves a were deemed relevant for the updated review. These 164 studies
linear regression between the intervention effect estimates and their were pooled with the 138 studies which had been identified from the
standard errors weighted by the inverse variance (Egger et al., 1997). previous EGM search, bringing the total count of included studies for
the effectiveness map to 302. Of these, 274 were excluded on the
basis of ineligible intervention or outcome type, while 28 studies
4.3.10 | Data synthesis across 15 countries were found to be eligible for inclusion in this
education review.
Data synthesis included: (1) extraction of basic study characteristics;
(2) a narrative summary of procedures and findings, including
recording of iatrogenic effects; (3) a summary of findings/results 5.1.2 | Included studies
table; (4) an assessment of confidence in study findings; and (5) a
forest plot of effect sizes. As noted under ‘Assessment of hetero- Table 4 presents a brief overview of the 28 included studies.
geneity’ above, we also coded effect sizes.
Participant characteristics and intervention setting

4.3.11 | Assessment of heterogeneity Target group. Most studies (n = 25) targeted children with disabilities.
Only two directly targeted family members, and three targeted ser-
Heterogeneity analysis was conducted for participant, intervention, vice providers (see Figure 3 below).3 However, there were several
and outcome characteristics. Because multiple effect sizes may be interventions which were primarily delivered via family members and
attributable to sampling error, a random effects model and the service providers. In these cases, while the child was still the inter-
associated inverse variance weight at the 95% confidence level was vention target, the family member of service provider was the
used for all analysis. The random effects model provides for an intervention recipient, but this was not evaluated with a formal
assumption of population variation from which the sample is drawn outcome measurement.
and calculates the effect size's impact by estimating that population's The socioeconomic status (SES) of participants was extremely
parameters. An I2 of 0%–40% was interpreted to be low heteroge- poorly reported, with 21 studies failing to report on this. Most studies
neity, 41%–80% moderate heterogeneity and 81% and above to included both male and female participants (n = 19). Two studies
mean high heterogeneity (Higgins et al., 2009). included only male participants. In seven cases, it was not possible to
tell the gender of the participants.
Individuals with intellectual or learning and developmental
4.3.12 | Treatment of qualitative research impairments were the most frequently targeted by included inter-
ventions (n = 16). This was followed by individuals with hearing
We did not include qualitative research in this systematic review. impairments (n = 7), physical impairments (n = 4), and then vision
impairments (n = 2). No studies identified in our review captured
education interventions for people with psychosocial/mental impair-
5 | RESULTS ments. Figure 4 below provides a visual summary of this distribution.

5.1 | Description of studies Location. Eight of the included studies were from India, four were from
Iran, two were from China and two were from South Africa and Egypt,
5.1.1 | Results of the search each. Brazil, Turkey, Jordan, Kenya, Lebanon, Romania, Malaysia, Nige-
ria, Uganda, and Zambia each contributed one study (see Figure 5
The Preferred Reporting Items for Systematic Reviews and Meta‐ below). In terms of World Bank regions, two studies came from East
Analyses (PRISMA) flowchart (Figure 2) outlines the steps we took Asia and the Pacific, one from Latin America and the Caribbean, nine
during the review process. Electronic databases searches yielded from the Middle East and North Africa, six from Sub‐Saharan Africa,
24,126 additional potentially relevant documents for review, while an eight from South Asia, and one from Europe and Central Asia.
additional 92 studies were identified from grey literature search, In many cases (n = 13), it was not possible to determine whether
reference and citation searching. The results from all three searches the study was conducted in a rural or urban setting. In 14 studies,
were combined, exported, and deduplicated using the reference urban participants were included, and in one study, the participants
management software Eppi reviewer 4 and we identified 1817
duplicates. We reviewed the titles and abstracts of the remaining 3
These categories are not mutually exclusive, as some interventions targeted both children
22,401 documents to determine potential relevance. We excluded and caregivers, or children and service providers.
TABLE 4 Intervention and outcome details by study.
HUNT

Study Country Design Sample size Intervention Education outcome domain(s)a

ET AL.

Adnams et al. (2007) South Africa RCT 65 A language and literacy intervention focused on training in phonological Educational attainment
awareness and acquisition of other pre‐ and early literacy skills

Akbari et al. (2019) Iran Controlled before versus 20 A computer assisted programme for working memory which aimed to Educational attainment
after improve executive functions and reading performance of students with
reading disorder

Altakhyneh (2019) Jordan Controlled before versus 60 Bruner's approach, developed and supported with the total communication Educational attainment
after method

Awada and Gutiérrez‐ Lebanon Controlled before versus 298 A programme delivering combined strategy instruction with the aim of Educational attainment
Colón (2017) after improving the reading comprehension of students with dyslexia

Carew et al. (2019) Kenya Uncontrolled before 130 The Leonard Cheshire Disability inclusive education training programme, Accessible learning environments;
versus after designed to increase teaching self‐efficacy, improve inclusive beliefs, attendance and completion
attitudes and practices, and reduce concerns around the inclusion of
children with disabilities among teachers

Costescu et al. (2015) Romania Controlled before versus 81 A robot‐assisted reversal learning task to improve cognitive flexibility Educational attainment
after

Devries et al. (2018) Uganda RCT 3820 The Good School Toolkit, a multi‐component school‐wide intervention Accessible learning environments
which aims to reduce physical violence from peers and school staff toward
students with and without disabilities in primary schools

Eissa (2009) Egypt Controlled before versus 67 A programme for school children based on self‐regulated strategy Educational attainment
after development with a view to improving writing skills

Hatamizadeh et al. (2020) Iran RCT 122 A resilience‐focused intervention focused on building behavioural Educational attainment
strengths and addressing difficulties of mainstreamed adolescent students
with hearing loss

Johnson (2018) India Controlled before versus 34 The Cognitive Orientation to Occupational Performance (CO‐OP) Educational attainment
after programme, which aims to improve handwriting performance in children
with Developmental Coordination Disorder (DCD)

Karahmadi et al. (2014) Iran RCT 52 A parent education intervention for children with reading and writing Educational attainment
disabilities

Karande et al. (2007) India Uncontrolled before 50 A parent education programme which aimed to educate parents of children Educational attainment
versus after with language disorders about the condition and the role of remedial
education

Katongo and Zambia Controlled before versus 60 A music intervention which involved ‘drilling songs’ [sic] toward improved Educational attainment
Ndhlovu (2015) after speech intelligibility of learners with postlingual hearing impairments
|

Kaur et al. (2008) India Controlled before versus 40 Comparative efficacy of multimedia, cognitive, and eclectic strategies on Educational attainment
after mathematical ability of children with learning disabilities

(Continues)
19 of 43
TABLE 4 (Continued)
20 of 43

Study Country Design Sample size Intervention Education outcome domain(s)a

|

Kumar and India Controlled before versus 64 A computer‐assisted instruction package (comprising games and Educational attainment
Chaturvedi (2014) after simulations) for remedial teaching for children with learning disabilities

Lal and Bali (2007) India Controlled before versus 30 Visual strategy training using objects, pictures, symbols, and manual signs Educational attainment
after for the development of communication skills

Lal (2010) India Uncontrolled before 8 The Makaton Vocabulary Language Programme, a system of alternative and Educational attainment
versus after augmentative communication (AAC) for children with autism

Lal and Ganesan (2011) India Controlled before versus 20 A social story intervention to improve self‐management skills in children Educational attainment
after with autism

Lee et al. (2019) China Uncontrolled before 8 An emotional skills intervention which aimed to improve behavioural and Educational attainment
versus after emotional competence and communication for children with autism

Martin et al. (2001) China Uncontrolled before 47 Teacher training techniques for teaching higher‐level critical and creative Educational attainment
versus after cognitive strategies to Deaf learners

Mohammed and Egypt Controlled before versus 68 Computer‐assisted instruction which aimed to improve child learning Educational attainment
Kanpolat (2010) after outcomes

Pawar and Mohite (2014) India Uncontrolled before 120 A self‐instructional module to improve primary school teachers' knowledge Accessible learning environments
versus after of learning disorders

Rezaiyan et al. (2007) Iran Controlled before versus 60 A computer programme that used a path‐finding game to improve Educational attainment
after attentional capacity among people with intellectual disabilities

Thai and Mohd Malaysia Controlled before versus 70 The Magic Finger Teaching Method, which entails manipulative techniques Educational attainment
Yasin (2016) after using the hands as well as the active involvement of the students in
performing arithmetic

Twilhaar (2012) South Africa Uncontrolled before 36 A Conductive Education (CE) intervention utilising a holistic educational Educational attainment
versus after system to teach and motivate children with cerebral palsy to participate
more in various domains

Ugwuanyi and Nigeria Uncontrolled before 33 Auditory training to improve reading comprehension among children with Educational attainment
Adaka (2015) versus after hearing impairments

Valentini and Brazil Controlled before versus 104 An inclusive mastery climate intervention including activities organised Educational attainment
Rudisill (2004) after around the following dimensions: Task, Authority, Recognition, Group,
Evaluation, and Time

Yildiz and Duy (2013) Turkey Controlled before versus 16 Interpersonal communication skills training Educational attainment
after
a
Outcomes related to domains other than education are not listed here.
HUNT
ET AL.
HUNT ET AL. | 21 of 43

FIGURE 3 Target group.

FIGURE 4 Participants by impairment type.

came from a mix of rural and urban settings. There were no studies coaches (n = 11), and about a third by community members or ex-
which specifically targeted rural participants. isting staff (n = 10). In the rest of the interventions (n = 7), it was
Table 5 below presents the intervention and outcome details of unclear who was responsible for delivery. Intervention settings were
included studies (Table 6). most commonly schools and classrooms in mainstream or inclusive
settings, followed by specialist school or resource rooms in inclusive
Study characteristics schools. The rest of the interventions were implemented in learning
disorder centres, Organisations of Persons with Disabilities, or in care
Study design. Of the 28 studies included, four were RCTs. 16 were facilities.4 In three studies, the site of intervention was not reported
controlled (before vs after), and the remaining eight were uncon- (see Table 7).
trolled (before vs after).

4
In some instances, studies did not clearly state where the intervention itself was im-
Intervention characteristics. About a third of the included interven-
plemented. In these instances, the site from which the participants were recruited was taken
tions were delivered by specialists, therapists, or intervention to be the setting of the intervention.
22 of 43 | HUNT ET AL.

FIGURE 5 Countries of included studies.

Regarding intervention content, coding was conducted according classes, with a view to improving learning outcomes among chil-
to the primary and, where there was one, secondary focus of the dren with disabilities.
intervention.5 All coding categories were not mutually exclusive and Within ‘Educational attainment support’, the interventions could
so multiple coding was done where an intervention covered more be organised according to sub‐categories. The frequency of each sub‐
than one category of intervention. category is presented in Table 8 below.
Across all studies, the category of interventions most commonly Clearly, many interventions focused on core competencies that
represented was ‘Educational attainment support’ (n = 28), followed could equip children to function in formal learning environments, but
by ‘Accessible learning environments’ (n = 16). Intervention catego- also in their broader environment(s). Examples of such programmes
ries were not mutually exclusive, given that some programmes were include the conductive education intervention documented in
multi‐component. Nonetheless, when mapped against our interven- Twilhaar (2012), which aimed to teach and motivate children with
tion categories (see Table 1 above), none of the interventions were cerebral palsy to participate and function in a range of activities
coded as focusing on ‘Attendance, enrolment, and completion’. including those relevant to classroom learning along with more
The types of interventions which fell under ‘Educational general skills, such as independent eating. Another example of an
attainment support’ included, for instance, a reading compre- outcome spanning both skills for formal learning and skills for life can
hension intervention that employed combined strategy instruction be seen in the intervention evaluated by Rezaiyan et al. (2007), which
(graphic organisers, visual displays, mnemonic illustrations, com- targeted attentional capacity through a computer game.
puter exercises, predicting, inference, text structure awareness, However, in most studies, there was a focus on developing chil-
main idea identification, summarisation, and questioning) for dren's capacity to engage in formal learning within educational settings.
children with dyslexia (Awada & Gutiérrez‐Colón, 2017). Indeed, These intervention components mostly centred on skills such as literacy
most of these interventions focused on testing specific strategies (Adnams et al., 2007; Akbari et al., 2019; Awada & Gutiérrez‐
– such as ‘drilling in singing’ [sic] (Katongo & Ndhlovu, 2015), Colón, 2017; Karahmadi et al., 2014; Ugwuanyi & Adaka, 2015) and
multimedia, cognitive strategies and eclectic approaches (Kaur numeracy (Adnams et al., 2007; Altakhyneh, 2019; Elmonayer, 2017;
et al., 2008), and systematic cognitive‐strategy instruction (Martin Kaur et al., 2008), or handwriting legibility (Eissa, 2009; Johnson, 2018).
et al., 2001) – in the context of either specialised or mainstream No interventions targeted education‐related quality of life.
Within the category of programming to improve ‘Accessible
learning environments’, intervention components could be cate-
5
An example of where this can be seen is in terms of the intervention domain ‘Rehabilitation
gorised according to the sub‐categories reflected in Table 9 below.
and health services, and assistive technologies’. Only two studies were coded as being focused The sub‐category most reflected among the interventions was
primarily on these domains. However, a total of 20 studies included assistive devices or reha-
‘Learning social environment and social inclusion’. In other words,
bilitation components, but not to the degree that warranted the intervention being coded as an
intervention for ‘Rehabilitation and health services, and assistive technologies’. these interventions aimed to improve the quality and/or
TABLE 5 Summary of findings by study.
HUNT

Confidence in study
ET AL.

Study Design Outcome domain findings Specific outcomes Unit of effect Effect sizea

Adnams et al. (2007) RCT Educational attainment High All sounds Standardised mean difference 0.54

Blending syllables Standardised mean difference 0.43

Blending Phonemes Standardised mean difference 1.32

Manipulating syllables Standardised mean difference 0.73

Manipulating Phonemes Standardised mean difference 0.45

Letter sounds Standardised mean difference 1.2

Written letters Standardised mean difference 1.02

Reading Standardised mean difference 1.21

Spelling Standardised mean difference 1.35

Akbari et al. (2019) Controlled before Educational attainment Low Planning and organising T‐test p < 0.05b
versus after
Inhibition and attention, T‐test p < 0.05b
displacement

Inhibition and attention T‐test p < 0.05

Working memory Standardised mean difference 0.93

Reading Standardised mean difference 3.83

Altakhyneh (2019) Controlled before Educational attainment Low Mathematical performance ANOVA p < 0.001b
versus after

Awada and Gutiérrez‐ Controlled before Educational attainment Low Comprehension of narrative texts Standardised mean difference 1.49
Colón (2017) versus after (Grade 7)

Comprehension of narrative texts Standardised mean difference 1.78

(Grade 8)

Comprehension of narrative texts Standardised mean difference 0.46

(Grade 9)

Comprehension of narrative texts Standardised mean difference 0.81

(Grade 10)

Carew et al. (2019) Uncontrolled before Accessible learning environments; Low Teaching self‐efficacy Standardised mean difference 2.20
versus after Attendance and completion
Beliefs Standardised mean difference 0.69

Feelings Standardised mean difference 0.70

|

Intentions Standardised mean difference 0.22

(Continues)
23 of 43
TABLE 5 (Continued)
24 of 43

Confidence in study
|

Study Design Outcome domain findings Specific outcomes Unit of effect Effect sizea

Self‐focused concerns Standardised mean difference −0.62

Other‐focused concerns Standardised mean difference −0.95

Costescu et al. (2015) Controlled before Educational attainment Low Errors in learning phase Standardised mean difference 0.87
versus after
Perseverative errors Standardised mean difference 0.51

Shared attention Standardised mean difference 0.98

Positive affect frequency Standardised mean difference 0.44

Regressive errors Standardised mean difference 0.27

Devries et al. (2018) RCT Accessible learning environments Low Any violence, staff or peers, aOR p = 0.077b
past week

Any violence, staff or peers, aOR p = 0.223b

past term

Any staff violence, past week aOR p = 0.342b

Any violence, staff, past term aOR p = 0.173b

Physical violence from staff, aOR p = 0.427b

past week

Physical violence from staff, aOR p = 0.481b

past term

Any peer violence, past week aOR p = 0.073b

Any peer violence, past term aOR p = 0.117b

Eissa (2009) Controlled before Educational attainment Low Writing Standardised mean difference 4.98
versus after

Hatamizadeh RCT Educational attainment Low Resilience T‐test p < 0.001b

et al. (2020)

Johnson (2018) Controlled before Educational attainment Low Visual motor integration Standardised mean difference 1.29
versus after
Visual perception Standardised mean difference 1.13

Motor Coordination Standardised mean difference 2.15

Word legibility Standardised mean difference 0.11

Letter legibility Standardised mean difference 1.3

Numeral legibility Standardised mean difference 0.57

HUNT
ET AL.
TABLE 5 (Continued)
HUNT

Confidence in study
ET AL.

Study Design Outcome domain findings Specific outcomes Unit of effect Effect sizea

Karahmadi et al. (2014) Educational attainment Low Speed reading Standardised mean difference 0.20

Reading accuracy Standardised mean difference 0.07

Percent of spelling scores Standardised mean difference 0.09

Karande et al. (2007) Uncontrolled before Accessible learning environments Low Parental knowledge of meaning of Standardised mean difference 2.66
versus after the term specific learning disabilities

Parental knowledge of remedial Standardised mean difference 1.52

education given by specialist

Meaning of the term remedial Standardised mean difference 2.73

education

Parental knowledge of frequency Standardised mean difference 2.86

and duration of remedial education
necessary to achieve academic
competence

Parental knowledge of meaning and Standardised mean difference 2.3

purpose of provisions

Parental knowledge about cause of Standardised mean difference 0.73

specific learning disabilities

Katongo and Controlled before Educational attainment Low Word intelligibility Standardised mean difference 0.9
Ndhlovu (2015) versus after
Short sentence construction Standardised mean difference 1.35

Kaur et al. (2008) Controlled before Educational attainment Low Mathematical skills: Control Standardised mean difference 6.62
versus after v Group 1

Mathematical skills: Control Standardised mean difference 4.32

v Group 2

Mathematical skills Control Standardised mean difference 6.93

v Group 3

Kumar and Controlled before Educational attainment Low Eye‐hand Coordination Standardised mean difference 1.66
Chaturvedi (2014) versus after
Figure‐Ground Perception Standardised mean difference 1.03

Figure Constancy Standardised mean difference 2.13

Position in Space Standardised mean difference 1.7

Spatial Relation Standardised mean difference 1.6

|

Auditory Perception Standardised mean difference 1.37

(Continues)
25 of 43
TABLE 5 (Continued)
26 of 43

Confidence in study
|

Study Design Outcome domain findings Specific outcomes Unit of effect Effect sizea

Cognitive Abilities Standardised mean difference 1.36

Memory Standardised mean difference 1.11

Receptive Language Standardised mean difference 1.29

Expressive Language Standardised mean difference 0.21

Lal and Bali (2007) Controlled before Educational attainment Low Composite score Mean difference p > 0.05b
versus after
Expressive language Mean difference p > 0.05b

Receptive language Mean difference p > 0.05b

Lal (2010) Uncontrolled before Educational attainment Low Social communicative behaviour Wilcoxon Signed Rank Test <0.01
versus after
Responsive and expressive language Wilcoxon Signed Rank Test <0.01

Lal and Ganesan (2011) Controlled before Educational attainment Low Rating scale for self‐management T‐test p < 0.001
versus after (RSSM): Classroom behaviour

Lee et al. (2019) Uncontrolled before Educational attainment Low Adaptive behaviour (including Standardised mean difference −0.63
versus after socialisation, communication)

Behavioural and functioning Standardised mean difference 0.96

(including school functioning)

Martin et al. (2001) Uncontrolled before Educational attainment Low Problem‐solving skills, critical ANOVA p < 0.003b
versus after thinking

Creative thinking ANOVA p > 0.05b

Mohammed and Controlled before Educational attainment Low Classification skills Standardised mean difference 9.86
Kanpolat (2010) versus after

Pawar and Uncontrolled before Learning social environment and Low Knowledge score Standardised mean difference 7.65
Mohite (2014) versus after social inclusion

Rezaiyan et al. (2007) Controlled before Educational attainment Low Attention score Standardised mean difference 0.78
versus after

Thai and Mohd Controlled before Educational attainment Low Multiplication achievement Standardised mean difference 0.49
Yasin (2016) versus after

Twilhaar (2012) Uncontrolled before Educational attainment Low Reaching Multiple regression coefficient p < 0.01b
versus after
Grasping Multiple regression coefficient p < 0.05b

Gross motor level Multiple regression coefficient p > 0.05b

Social responsiveness Multiple regression coefficient p > 0.05b

HUNT
ET AL.
HUNT ET AL. | 27 of 43

inclusiveness of learning social environments. Among programmes

Effect sizea

Standardised effect sizes are presented, except for cases where information necessary to calculate them was missing from the publication. In these latter instances, author‐reported p‐values are given.
p = 0.323b

p = 0.824b
coded under this sub‐category were those that aimed to improve

p > 0.05b
social skills (Lee et al., 2019) and reduce rates of victimisation of

3.14

0.20
children with disabilities in school (Devries et al., 2018). Other sub‐
categories reflected in the literature included ‘Structural interven-
Multiple regression coefficient

Standardised mean difference

Standardised mean difference

tions’ (n = 1) (Carew et al., 2019), ‘Anti‐bullying policies and pro-
grammes’ (n = 1) (Devries et al., 2018), ‘Educational services devel-
opment’ (n = 6) (Carew et al., 2019; Pawar & Mohite, 2014), and
‘Rehabilitation and health services, and assistive technologies’
Unit of effect

(Lal, 2010). No studies represented the intervention categories of

‘Accessibility of built environment and learning materials’ or ‘Inclusive
f‐test

f‐test

education policies’.

Outcome characteristics
The category of outcome most frequently reflected in the studies
was ‘Educational attainment’ (n = 31), followed by ‘Accessible learn-
Cognitive play performance

Locomotor performance

ing environments’ (n = 6). Again, categories were not mutually ex-

Communication skills

clusive, given that some programmes had multiple outcomes. The

Specific outcomes

category ‘Attendance, enrolment, and completion’ was not repre-

sented among the outcomes.
As observed in these interventions, ‘Educational attainment’
Empathy
Reading

outcomes could be broken down into those focused on ‘Skills for

formal/learning in schools’ (n = 22) and ‘Skills for life’ (n = 12), as
shown in Table 10. Exemplary among skills for formal learning/
Confidence in study

learning in schools were outcomes such as comprehension of nar-

rative texts (Awada & Gutiérrez‐Colón, 2017) and mathematical skills
(Kaur et al., 2008). Those exemplary among the ‘Skills for life’ cate-
findings

gory were outcomes such as word intelligibility (Katongo &

Low

Low

Low

Ndhlovu, 2015), as well as problem‐solving skills and critical thinking

(Martin et al., 2001). ‘Education‐related quality of life’ was not rep-
resented among the study outcomes.
The outcome category of ‘Accessible learning environments’
reflected the sub‐categories shown in Table 11. The most frequently
Educational attainment

Educational attainment

Educational attainment

represented sub‐categories were ‘Strengthened learning social en-

Outcome domain

vironment and improved social inclusion’ (Carew et al., 2019;

Karande et al., 2007; Pawar & Mohite, 2014) and ‘Educational ser-
vices development’ (Carew et al., 2019; Valentini & Rudisill, 2004).
These were followed by ‘Reduced rates of bullying/victimisation in
educational setting’ (Devries et al., 2018). Outcomes for the category
of ‘Strengthened learning social environment and improved social
Uncontrolled before

inclusion’ included, for instance, improved teacher intentions to

Controlled before

Controlled before

include children with disabilities in mainstream classes (Carew

et al., 2019), while examples of ‘Educational services development’
versus after

versus after

versus after

can be seen in Carew et al.'s (2019) intervention, which was focused

Design

on teaching self‐efficacy. Finally, ‘Reduced rates of bullying/victimi-

sation in educational setting’ was reported on by Devries and col-
Author‐reported p‐values.
(Continued)

leagues (Devries et al., 2018), who looked at past‐week physical

Yildiz and Duy (2013)

violence from a school staff member as self‐reported by students

with disabilities.
Ugwuanyi and

Rudisill (2004)
Adaka (2015)

Valentini and

The outcome category of ‘Attendance, enrolment, and comple-

TABLE 5

tion’ was not represented among the outcomes of any studies.

Study

Table 6 (above) presents a summary of the findings of this

review, by outcome of interest.
b
a
28 of 43 | HUNT ET AL.

TABLE 6 Summary of findings by outcome.

Outcome domain Outcome sub‐category Specific outcome Number of participants

Educational Skills for formal/learning in • Reading ability (Adnams et al., 2007; Akbari 65 (Adnams et al., 2007)
attainment schools et al., 2019; Awada & Gutiérrez‐ 20 (Akbari et al., 2019)
Colón, 2017; Karahmadi et al., 2014; 60 (Altakhyneh, 2019)
Ugwuanyi & Adaka, 2015) 298 (Awada & Gutiérrez‐
• Numeracy and mathematical ability (Adnams Colón, 2017)
et al., 2007; Altakhyneh, 2019; 81 (Costescu et al., 2015)
Elmonayer, 2017; Kaur et al., 2008) 67 (Eissa, 2009)
• Spelling (Adnams et al., 2007; Karahmadi 5 (Elmonayer, 2017)
et al., 2014) 34 (Johnson, 2018)
• Handwriting performance (Eissa, 2009; 52 (Karahmadi et al., 2014)
Johnson, 2018) 60 (Katongo & Ndhlovu, 2015)
• Communication skills (Katongo & 40 (Kaur et al., 2008)
Ndhlovu, 2015; Lal & Bali, 2007; Lal, 2010) 64 (Kumar & Chaturvedi, 2014)
• Remediation of learning disability [sic] 30 (Lal & Bali, 2007)
(Kumar & Chaturvedi, 2014) 8 (Lal, 2010)
• Reasoning and classification skills (Martin 20 (Lal & Ganesan, 2011)
et al., 2001; Mohammed & Kanpolat, 2010) 47 (Martin et al., 2001)
• Critical and creative thinking (Martin 68 (Mohammed & Kanpolat, 2010)
et al., 2001) 60 (Rezaiyan et al., 2007)
• Cognitive and executive functioning (Akbari 70 (Thai & Mohd Yasin, 2016)
et al., 2019; Costescu et al., 2015; Martin 36 (Twilhaar, 2012)
et al., 2001; Twilhaar, 2012) 33 (Ugwuanyi & Adaka, 2015)
• Attention (Rezaiyan et al., 2007) 104 (Valentini & Rudisill, 2004)
• Classroom behaviour (Lal & Ganesan, 2011)
• Mathematic skill readiness (Kaur et al., 2008)

Skills for life • Social responsiveness (Twilhaar, 2012) 81 (Costescu et al., 2015)
• Motor function (Twilhaar, 2012) 122 (Hatamizadeh et al., 2020)
• Behaviour and social skills (Lal & 60 (Katongo & Ndhlovu, 2015)
Ganesan, 2011; Lal, 2010; Lee et al., 2019) 30 (Lal & Bali, 2007)
• Speech intelligibility (Katongo & 8 (Lal, 2010)
Ndhlovu, 2015) 20 (Lal & Ganesan, 2011)
• Communication skills (Lal & Bali, 2007; 8 (Lee et al., 2019)
Lal, 2010; Yildiz & Duy, 2013) 60 (Rezaiyan et al., 2007)
• Emotional skills (Lee et al., 2019; Yildiz & 36 (Twilhaar, 2012)
Duy, 2013) 104 (Valentini & Rudisill, 2004)
• Attention (Costescu et al., 2015; Rezaiyan 16 (Yildiz & Duy, 2013)
et al., 2007)
• Resilience (Hatamizadeh et al., 2020)
• Motor function (Twilhaar, 2012; Valentini &
Rudisill, 2004)

Accessible learning Strengthened learning social • Teacher beliefs, feelings, and intentions 130 (Carew et al., 2019)
environments environment and improved social about inclusive education [52] 50 (Karande et al., 2007)
inclusion • Teacher concerns about inclusive 60 (Pawar & Mohite, 2014)
education [52]
• Parental knowledge, attitudes, and practices
about remedial education (Karande
et al., 2007)

Reduced rates of bullying/ • Physical violence from a school staff 3820 (Devries et al., 2018)
victimisation in educational member (Devries et al., 2018)
setting

Educational services development • Teaching self‐efficacy (Carew et al., 2019) 130 (Carew et al., 2019)
• Knowledge of Primary School Teachers 60 (Pawar & Mohite, 2014)
Regarding
• Learning Disorders (Pawar & Mohite, 2014)
HUNT ET AL. | 29 of 43

TABLE 7 Intervention setting. 5.1.3 | Excluded studies

Schools and classrooms (inclusive) 13
The number of excluded studies is recorded in the PRISMA diagram
Learning disorder centres 2
above (Figure 2). Examples of excluded studies with the associated
Specialist schools and resource rooms 8 reason for exclusion are presented in Annex S1C. The most common
Organisations of persons with disabilities 1 reason for exclusion was an insufficient sample size (<5 participants).
An important note regarding the exclusions of this review con-
Care facility 1
cerns ECD interventions. When the protocol for review was first
Not reported 3
developed, the authors envisaged that preschool and ECD interven-
tions would be included. However, once the review was undertaken,
this posed two challenges:

T A B L E 8 Sub‐categories of ‘Educational attainment support’

intervention category. 1. The types of interventions and outcomes evaluated in many ECD
interventions are not clearly ‘education’ interventions or out-
Skills for formal/learning in schools 20
comes; and
Skills for life 9 2. The ECD literature in respect of child development and devel-
Education‐related quality of life 0 opmental disabilities is well‐summarised elsewhere.

To further explain, most of the ECD literature examines behavioural

and parenting interventions delivered by teachers, or teachers plus
T A B L E 9 Sub‐categories of ‘Accessible learning environments’ trainers, to young children, with the aim of ‘managing’ children's beha-
intervention category. viour. While these interventions are sometimes framed as education
interventions, they are just as often framed as health interventions.
Structural interventions 3
Moreover, while it is plausible that interventions focused on strength-
Learning social environment and social inclusion 7
ening eye contact or reducing ‘problem behaviours’ [sic] may lead to
Accessibility of built environment and learning materials 0 better learning over time, the idea that these interventions, their aims, or
Anti‐bullying policies and programmes 1 their outcomes are ‘education‐focused’ is debatable. Finally, a large
number of reviews have already examined the ECD literature (Emmers
Educational services development 6
et al., 2021; Jeong et al., 2021; Kohli‐Lynch et al., 2019; Oono
Inclusive education policies 0
et al., 2013) so it is questionable whether any value would be added by
Rehabilitation and health services, and assistive technologies 1 including these studies in another evidence synthesis. As such, the
decision was taken to exclude papers where the target group was
children under 6 years of age. Nonetheless, we provide a brief summary
of the identified ECD literature in Table 12 below.
T A B L E 10 Sub‐categories of ‘Educational attainment’ outcome
category.

Skills for formal/learning in schools 22 5.2 | Confidence in study findings in included

Skills for life 12 studies
Education‐related quality of life 0
Besides one study which had a high overall confidence rating (Adnams
et al.), all other included studies had an overall rating of low confidence in
study findings (see Table 13). The overall confidence in these studies is
T A B L E 11 Sub‐categories of ‘Accessible learning environments’ generally low, primarily due to the low rigour in design and execution.
outcome category.
Masking was often not implemented, and attrition rates were not con-
Strengthened learning social environment and improved social 3 sistently reported, which affects the reliability of the findings. Disability
inclusion and outcome measures varied in quality, with many studies failing to
Improved accessibility of built environment and learning 0 achieve a high rating. Baseline balance was also frequently low, indicating
materials issues with the initial equivalence of groups. Collectively, these method-
Reduced rates of bullying/victimisation in educational setting 1 ological shortcomings highlight the need for more rigorous research
designs in future studies to provide more reliable and generalisable
Educational services developed 2
results.
Provision and utilisation of rehabilitation and health services, and 0
As our assessment tool assigned studies an overall rating based
assistive technologies
on the lowest rating on any criteria, we discuss confidence in study
30 of 43 | HUNT ET AL.

T A B L E 12 Interventions excluded due to child age.

Intervention Child age Country Outcome(s)

Elmonayer (2017) Visual scaffolding intervention to Mean age = 5.4 years Egypt Number sense
promote number sense

Juneja A parent‐based behavioural Mean age = 3.3 years India Child behaviour, Developmental
intervention programme Quotient, Social Maturity, Receptive
language, Expressive language

Karaaslan and A responsive teaching intervention Mean age = 4.6 years Turkey Maternal behaviour, Child behaviour
Mahoney (2013)

Karanth et al. (2010) An indigenous early childhood Age range = 2.2–5.5 years India Child behaviour
development intervention

Pajareya and A parent‐based behavioural Age range = 2–6 years Thailand Functional emotional development,
Nopmaneejumruslers (2011) intervention programme Child behaviour

Pajareya and A parent‐based behavioural Age range = 2–6 years Thailand Functional emotional development,
Nopmaneejumruslers (2012) intervention programme Child behaviour

Sarouphim and A family‐based early childhood Age range = 1–3 years Lebanon Child development
Kassem (2020) development intervention

Shin et al. (2009) A parent‐based behavioural Age range = 3–6 years Vietnam Child behaviour
intervention programme

findings by domain below, to present a more nuanced picture of et al., 2008; Kumar & Chaturvedi, 2014; Lal & Bali, 2007; Lal, 2010; Lee
quality and risk of bias in the included literature. et al., 2019; Mohammed & Kanpolat, 2010; Thai & Mohd Yasin, 2016;
Most low rated studies received a rating that led to their overall Ugwuanyi & Adaka, 2015). Low ratings were generally given due to a
downgrading due to their study design. Twenty‐four studies (Akbari failure to report attrition.
et al., 2019; Altakhyneh, 2019; Awada & Gutiérrez‐Colón, 2017; Carew For the clarity and reliability of the disability/impairment measure
et al., 2019; Costescu et al., 2015; Eissa, 2009; Johnson, 2018; Karande used in reference to the target group in studies, four papers received a
et al., 2007; Katongo & Ndhlovu, 2015; Kaur et al., 2008; Kumar & rating of low (Martin et al., 2001; Rezaiyan et al., 2007; Twilhaar, 2012;
Chaturvedi, 2014; Lal & Bali, 2007; Lal & Ganesan, 2011; Lal, 2010; Lee Valentini & Rudisill, 2004), eight received a medium rating
et al., 2019; Martin et al., 2001; Mohammed & Kanpolat, 2010; Pawar & (Altakhyneh, 2019; Costescu et al., 2015; Hatamizadeh et al., 2020;
Mohite, 2014; Rezaiyan et al., 2007; Thai & Mohd Yasin, 2016; Twilhaar, Katongo & Ndhlovu, 2015; Lal & Ganesan, 2011; Lee et al., 2019;
2012; Ugwuanyi & Adaka, 2015; Valentini & Rudisill, 2004; Yildiz & Ugwuanyi & Adaka, 2015; Yildiz & Duy, 2013), and the rest were rated as
Duy, 2013) were categorised as low on design, while only four were high (Adnams et al., 2007; Akbari et al., 2019; Awada & Gutiérrez‐
categorised as high (Adnams et al., 2007; Devries et al., 2018; Colón, 2017; Devries et al., 2018; Eissa, 2009; Johnson, 2018; Karahmadi
Hatamizadeh et al., 2020; Karahmadi et al., 2014). Low ratings were et al., 2014; Karande et al., 2007; Lee et al., 2019; Mohammed &
chiefly given because of the use of controlled or uncontrolled before‐ Kanpolat, 2010; Thai & Mohd Yasin, 2016; Valentini & Rudisill, 2004). For
versus‐after designs. The four high confidence ratings were given two studies, no rating was given as the target group of intervention was
for RCTs. teachers without disabilities (Carew et al., 2019; Pawar & Mohite, 2014).
In the cases where reporting of masking was applicable (the To aid interpretation and reliability of findings for comparability
RCTs), one of these studies was rated as medium (Devries with other studies, outcome measures must be clearly defined. Against
et al., 2018), for motivating that the failure to mask was due to the this criterion, two studies received a low rating (Pawar & Mohite, 2014;
nature of the intervention. Two were rated as high (Adnams Rezaiyan et al., 2007), three received ratings of medium (Awada &
et al., 2007; Hatamizadeh et al., 2020), for reporting masking of data Gutiérrez‐Colón, 2017; Costescu et al., 2015; Valentini &
collection and masking for analysis. One study (Karahmadi Rudisill, 2004), and the rest received ratings of high (Adnams
et al., 2014) received a low rating for failure to report on masking. et al., 2007; Akbari et al., 2019; Altakhyneh, 2019; Carew et al., 2019;
Ratings for attrition were based on losses to follow up being pre- Devries et al., 2018; Eissa, 2009; Hatamizadeh et al., 2020;
sented and acceptable. 11 studies received low ratings on loss to follow Johnson, 2018; Karahmadi et al., 2014; Karande et al., 2007; Katongo
up (Awada & Gutiérrez‐Colón, 2017; Costescu et al., 2015; Devries & Ndhlovu, 2015; Kaur et al., 2008; Kumar & Chaturvedi, 2014; Lal &
et al., 2018; Hatamizadeh et al., 2020; Lal & Ganesan, 2011; Martin Bali, 2007; Lal & Ganesan, 2011; Lal, 2010; Lee et al., 2019; Martin
et al., 2001; Pawar & Mohite, 2014; Rezaiyan et al., 2007; et al., 2001; Mohammed & Kanpolat, 2010; Thai & Mohd Yasin, 2016;
Twilhaar, 2012; Valentini & Rudisill, 2004; Yildiz & Duy, 2013), while 17 Twilhaar, 2012; Ugwuanyi & Adaka, 2015; Yildiz & Duy, 2013). In the
were rated as high (Adnams et al., 2007; Akbari et al., 2019; case of these high ratings, studies had reported the outcomes being
Altakhyneh, 2019; Carew et al., 2019; Johnson, 2018; Karahmadi used (with a definition) and had provided the basis on which they were
et al., 2014; Karande et al., 2007; Katongo & Ndhlovu, 2015; Kaur measured, often employing widely used and validated measures.
T A B L E 13 Confidence in study findings appraisal.
HUNT

Design Masking Attrition Disability measure Outcome measure Baseline balance Overall
ET AL.

Study Design Low Medium High Low Medium High Low Medium High Low Medium High Low Medium High Low Medium High Low Medium High

Adnams RCT ● ● ● ● ● ● ●
et al. (2007)

Akbari Controlled ● ● ● ● ● ●
et al. (2019) before versus
after

Altakhyneh Controlled ● ● ● ● ● ●
(2019) before versus
after

Awada and Controlled ● ● ● ● ● ●

Gutiérrez‐ before versus
Colón (2017) after

Carew Uncontrolled ● ● ● ●
et al. (2019) before versus
after

Costescu Controlled ● ● ● ● ● ●
et al. (2015) before versus
after

Devries RCT ● ● ● ● ● ● ●
et al. (2018)

Eissa (2009) Controlled ● ● ● ● ● ●

before versus
after

Hatamizadeh RCT ● ● ● ● ● ● ●
et al. (2020)

Johnson Controlled ● ● ● ● ● ●
(2018) before versus
after

Karahmadi RCT ● ● ● ● ● ● ●
et al. (2014)

Karande Uncontrolled ● ● ● ● ●
et al. (2007) before versus
after

Katongo and Controlled ● ● ● ● ● ●

|

Ndhlovu before versus

(2015) after

(Continues)
31 of 43
TABLE 13 (Continued)
32 of 43

Design Masking Attrition Disability measure Outcome measure Baseline balance Overall
|

Study Design Low Medium High Low Medium High Low Medium High Low Medium High Low Medium High Low Medium High Low Medium High

Kaur Controlled ● ● ● ● ● ●
et al. (2008) before versus
after

Kumar and Controlled ● ● ● ● ● ●

Chaturvedi before versus
(2014) after

Lal and Controlled ● ● ● ● ● ●

Bali (2007) before versus
after

Lal (2010) Uncontrolled ● ● ● ● ●

before versus
after

Lal and Controlled ● ● ● ● ● ●

Ganesan before versus
(2011) after

Lee Uncontrolled ● ● ● ● ● ●
et al. (2019) before versus
after

Martin Uncontrolled ● ● ● ● ●
et al. (2001) before versus
after

Mohammed Controlled ● ● ● ● ● ●
and before versus
Kanpolat after
(2010)

Pawar and Uncontrolled ● ● ● ●

Mohite before versus
(2014) after

Rezaiyan Controlled ● ● ● ● ● ●
et al. (2007) before versus
after

Thai and Controlled ● ● ● ● ● ●

Mohd before versus
Yasin (2016) after
HUNT
ET AL.
HUNT ET AL. | 33 of 43

Of the 20 studies for which baseline balance was applicable for

High
assessment (excluding uncontrolled before vs. after studies), 11
Low Medium received low ratings (Akbari et al., 2019; Altakhyneh, 2019; Awada &
Gutiérrez‐Colón, 2017; Johnson, 2018; Katongo & Ndhlovu, 2015;
Kaur et al., 2008; Kumar & Chaturvedi, 2014; Lal & Bali, 2007; Lal &
Overall

Ganesan, 2011; Valentini & Rudisill, 2004; Yildiz & Duy, 2013), 4
●

●
received medium ratings (Eissa, 2009; Mohammed & Kanpolat, 2010;
Low Medium High

Rezaiyan et al., 2007; Thai & Mohd Yasin, 2016), and 5 received a
high rating (Adnams et al., 2007; Costescu et al., 2015; Devries
Baseline balance

et al., 2018; Hatamizadeh et al., 2020; Karahmadi et al., 2014).

5.3 | Effects of interventions

●

●
Low Medium High

Included studies concerned with ‘Conditions for inclusion of people with

●

●
Outcome measure

disabilities in education’ showed a moderately significant effect, and one

study concerned with teacher knowledge showed a significant effect size
●

(see Figure 6). However, these studies showed a large heterogeneity and
a potential publication bias (see Figure 7). The main limitation in this case
was the low number of studies concerned with this topic (Table 14).
Low Medium High

The forest plot (Figure 8) below displays the overall effect of the
●
Disability measure

intervention on ‘Skills for learning’. The forest plot also indicates that
interventions tended to have a large effect on skills, but that there was
high heterogeneity across published sources and sample sizes tended to
●

be low. The joint effect was significant, at an alpha level of 5%, but it
●

presents considerable heterogeneity and a marginally significant publi-

High

cation bias.
●

When considering the effect of intervention on different

Low Medium

outcomes, we see that the effect on cognitive skills, numeracy,

speech and communication is insignificant. The studies concerned
Attrition

with speech and school behaviour show no significant effect of

intervention. In both cases, only 2 out of 5 studies showed an
●

effect size different from 0. Literacy interventions demonstrate

High

moderate effect but high heterogeneity (I² = 92.09%), with an

Note: Grey blocks indicate where a criterion was not applicable to a study.

effect size of 2.64 (CI: [1.21, 4.06]). Handwriting exhibits a sig-

Low Medium

nificant and a large effect of 4.97 (CI: [4.21, 5.73]) with low
Masking

heterogeneity (I² = 0.00%) but this is based on only two studies.

The overview of the funnel plot (Figure 9) likewise shows that the
former two categories are likely to suffer from publication bias,
High

even though the Eggers Test is insignificant, due to a low sample

size. The publication bias for numeracy and handwriting cannot
Low Medium

be assessed, as the number of studies is only two.

Design

5.4 | Synthesis of results

Uncontrolled ●

Uncontrolled ●

●
before versus

before versus

before versus

before versus
(Continued)

Valentini and Controlled

Controlled

6 | D IS CU SS IO N
Design

after

Adaka (2015) after

after

after

6.1 | Summary of main results

TABLE 13

Duy (2013)
Ugwuanyi

Yildiz and
Twilhaar

We identified, coded, analysed, and narratively summarised the find-

Rudisill
(2012)

(2004)
Study

ings from 28 studies that evaluated interventions to improve the

and

educational outcomes of people with disabilities in LMICs. These 28

34 of 43 | HUNT ET AL.

FIGURE 6 Overall effect size of interventions concerned with conditions for inclusion.

from Europe and Central Asia, and one from Latin America and the
Caribbean. Geographic setting (urban/rural) was not reported in over
half of the studies, and participant SES was poorly reported, with the
vast majority of studies not reporting on it.
In terms of study characteristics, most of the included studies
employed controlled before versus after designs, followed by
uncontrolled before versus after designs. A minority of studies
used an RCT design.
Overall, only one study received a rating of ‘high’ confidence and
all other included studies received ratings of ‘low’ on the confidence
in study findings tool. Low ratings were driven by the widespread use
of low‐rigour study designs, as well as failures to report important
information such as balance, masking, and attrition.
The interventions under study were mostly delivered in main-
FIGURE 7 Potential bias in studies concerned with conditions for stream settings, but this majority was not huge. Thirteen interven-
inclusion. tions were conducted in (inclusive) mainstream settings, while 12
happened in segregated or specialised settings, and a further 3 did
not report on their setting. Most interventions were delivered by
studies served as the data for this review and are reported on ac- specialists, therapists or intervention coaches, and the minority by
cording to the interventions and outcomes identified across all studies. community members or existing staff.
In terms of target group, the vast majority of studies concerned The outcomes most frequently reflected in the reviewed studies
interventions for individuals with intellectual, learning, and/or were those which concerned educational attainment. This was fol-
developmental conditions. Most interventions were undertaken with lowed in frequency by studies which looked at improving the
disabled children, with a few targeting service providers, teachers, or accessibility of learning environments. No study looked at outcomes
family. Almost all studies targeted both male and female participants. related to attendance, enrolment, and completion of people with
If examined by World Bank region, there were eight studies from disabilities in education. No studies reported on outcomes such as
South Asia, eight from the Middle East and North Africa, six qualifications gained, transition to higher levels of education, or
from Sub‐Saharan Africa, three from East Asia and the Pacific, two education‐related quality of life.
HUNT ET AL. | 35 of 43

T A B L E 14 Effects of interventions.
Outcome Effect Summary

Conditions for d = 0.35 (0.12 to 0.58) Moderate effect based on a low

inclusion of people k=4 number of studies with high
with disabilities in n = 401 heterogeneity and potentially
education I² = 86% moderate publication bias
Egger's test
2.01 (t = 1.43, p = 0.29)

Skills for learning Speech and d = 0.70 (−1.70 to 3.09) Insignificant effect based on a low
communication k=5 number of studies with high
n = 245 heterogeneity and no publication bias
I² = 90%
Egger's test
0.25 (t = 0.09, p = 0.93)

School behaviour d = 0.49 (−1.76 to 2.74) Insignificant effect based on a low

and adaptive k=5 number of studies with low
functioning n = 256 heterogeneity and no publication bias
I² = 0%
Egger's test
0.11 (t = 1.03, p = 0.38)

Numeracy d = 4.60 (0.69 to 8.50) High effect based on a low number of

k=2 studies with high heterogeneity. The
n = 110 publication bias cannot be assessed
I² = 85% due to low sample size
Egger's test
Low sample size

Literacy d = 2.46 (0.01 to 4.90) Large effect based on a low number

k=4 of studies with high heterogeneity
n = 389 and potentially high publication bias
I² = 93%
Egger's test
3.61 (t = 1.66, p = 0.24)

Handwriting d = 4.86 (0.25 to 9.48) Large effect based on a low number

k=2 of studies with low heterogeneity.
n = 101 The publication bias cannot be
I² = 0% assessed due to low sample size
Egger's test
Low sample size

Cognitive skills, d = 3.38 (0.96 to 5.80) Large effect based on a low number
including attention k=4 of studies with high heterogeneity
and memory n = 212 and potentially high publication bias
I² = 100%
Egger's test
15.30 (t = 0.99, p = 0.43)

Overall d = 2.10 (0.91 to 3.29) Large effect based on a large number

k = 22 of studies with high heterogeneity
n = 1313 and marginally significant
I² = 99% publication bias
Egger's test
5.24 (t = 1.93, p = 0.07)

Note: d < 0.2 small, 0.2 < d < 0.6 moderate and d > 0.6 large. k < 10 small, 10 ≤ k < 20 moderate and k ≥ 20 large (k = number of studies). I² < 0.4 low,
0.4 ≤ I² < 0.8 moderate and I² ≥ 0.8 high. n = total number of participants.

Among those studies which aimed to improve educational adaptive functioning. Studies that were aimed at improving the
attainment, positive effects of interventions were seen for speech accessibility of learning environments in education reported positive
and communication; literacy; numeracy; handwriting; cognitive impacts of these interventions on teacher knowledge and attitudes,
skills, including attention and memory; and school behaviour and parent knowledge and attitudes, and violence reduction. Finally,
36 of 43 | HUNT ET AL.

F I G U R E 8 Overall effect of the

intervention(s) on skills for learning.

attempts to improve attendance, enrolment, and completion among The interventions and outcome measures used by the included
people with disabilities by equipping mainstream settings for the studies were all different, making direct comparison (e.g., across
attendance of children with disabilities, was achieved in one study, countries) difficult. Most interventions tried to improve children's
where teacher knowledge and attitudes about inclusive education skills but did not focus on system‐level or school‐level changes. None
were improved. of the studies were undertaken in humanitarian settings, and while
HUNT ET AL. | 37 of 43

FIGURE 9 Potential bias in interventions concerned with skills for learning.

almost all were undertaken with both male and female participants, 6.5 | Agreements and disagreements with other
few disaggregated their findings by gender. studies or reviews

Our findings largely concur with other reviews which have been con-
6.2 | Overall completeness and applicability of ducted in the area, especially in the need for additional and more rig-
evidence orous studies to be conducted, and reporting quality to be improved.
From the Cochrane databases, a review by Pennington et al. (2018)
The evidence presented here provides emerging support for the assessed the effectiveness of parent‐mediated communication inter-
efficacy and effectiveness of interventions to improve the education ventions, for improving the communication skills of preschool children
outcomes among people with disabilities in LMICs. However, due to up to 5 years of age who have non‐progressive motor disorders. Our
the broad variety of interventions and outcomes assessed under the review differed somewhat from the 2018 review in that we excluded
domain of education, and the limited number of high‐quality RCT and ECD interventions (where the outcomes only pertained to child
quasi‐experimental studies available, more research is needed to developmental progress on standardised measures), because we oper-
understand which types of interventions are most efficacious, and ationalised educational outcomes as different to those relating to global
how best to deliver them. development and functioning. However, Pennington et al. also found
that their conclusions were limited by the low quality, and general
dearth, of evidence in this area. They called for research with larger
6.3 | Quality of the evidence numbers of children, and for improved reporting standards, both of
which are echoed by the findings of our review.
The quality of the included studies is largely low, as determined by the A review of the evidence concerning music education for im-
confidence in study findings tool used in this review. Most study designs proving reading skills in children and adolescents with dyslexia by
employed were unable to consider many potential confounders. More- Cogo‐Moreira et al. (2012) found that there was no evidence avail-
over, masking, baseline balance, and attribution were poorly reported. able from RCTs to inform judgments about the effectiveness of these
programmes. While we did not find any RCTs evaluating music
education, we did identify a study by Katongo and Ndhlovu (2015)
6.4 | Potential biases in the review process which examined the impact of a music intervention on speech
intelligibility of learners with hearing impairments. However, the
Potential bias may be introduced about the lack of grey literature study was not an RCT and given that it stood alone and pooled
included in the review, as well as the absence of non‐English analysis was not possible, we cannot draw any specific conclusions
literature. about this modality of intervention.
38 of 43 | HUNT ET AL.

Another Cochrane review, which examined task‐oriented inter- and social inclusion outcomes respectively, also by our team. The EGM
ventions for children with developmental co‐ordination disorder also did not find many studies conducted with primary and secondary
(Miyahara et al., 2017), found that while beneficial effects of inter- school‐aged participants, which we have included in this review. Again,
ventions were reported across most studies, there was very little this is due to different inclusion criteria, partly because the EGM included
confidence to be had in a positive effect estimate. Like Pennington vocational training with livelihoods outcomes while this review did not.
et al. (2018), Miyahara et al. (2017) also called for carefully designed
and executed RCTs in this area.
Other more topic‐specific rigorous reviews have been conducted 7 | AU THORS' C ONC LU SI ONS
and reported in the peer‐reviewed literature (Buysse & Bailey, 1993;
Elbaum et al., 1999; Forlin et al., 2013; Gersten et al., 2001; Hudson Children with disabilities fall behind in educational outcomes as the
et al., 2013; Katz & Mirenda, 2002; Paradise et al., 2009; Pierce current school systems are not set up to teach children with different
et al., 2004; Purdie et al., 2002; Reichrath et al., 2010; Ruijs & impairment types. There is no one ‘magic bullet’ intervention which
Peetsma, 2009; Trout et al., 2003; Wapling, 2016). can equalise health outcomes for this group. A twin‐track approach is
Reichrath et al. (2010) investigate the interventions used in needed, which both addresses the specific needs of children with
general education and what is known about their effectiveness. They disabilities but also ensures that they are included in mainstream
found that all of the eight reading interventions they found and re- activities (e.g., through improving the skills of teachers and accessi-
viewed seem to have had positive influences on reading skills. bility of the classroom). However, currently most interventions
However, the methodological quality in some studies was low. included in this systematic review targeted individual children with
Ruijs and Peetsma (2009) examined the impacts of inclusive disabilities in an attempt to improve their functioning, skills, and
education environments on children with special education needs competencies, but did not focus on mainstreaming these children into
and children without special education needs. Their review showed the school by system‐level or school‐level changes. Consequently, a
neutral to positive effects of inclusive education on academic focus on interventions which target not just the individual with a
achievement. However, they noted that children with special edu- disability but also their broader environment, is needed.
cational needs seem to have a less favourable social outcomes in
mainstream settings compared to children without special educa-
tional needs. Our review did not reveal any systematic differences 7.1 | Implications for practice
between the effectiveness of interventions delivered in mainstream
or segregated/specialised settings, but this was likely due to the • Most interventions tried to improve children's functioning, skills,
majority of interventions reporting positive findings. and competencies, but did not focus on system‐level or school‐
Wapling (2016) conducted a systematic review to examine level changes, that is, changes at a wider institutional level.
strategies being used in education for children with disabilities in Interventions which target both the individual with a disability,
LMICs. Their review was not focused on impact evaluations only, so such as provision of speech‐to‐text software and their broader
many of the findings are not comparable to those in our review. environment(s), such as teacher training programmes and curric-
However, the authors also noted the absence of literature analysing ulum modifications, are needed.
outcomes related to academic achievement as a significant gap in the • Efforts should also be made to integrate measures of disability
research. While our review identified some studies that looked at within planned or ongoing mainstream education impact evalua-
academic functioning, skills and competencies, we also failed to find tions and other demographic or household surveys that include
any which reported on more finite outcomes, such as qualifications education outcomes.
gained and successful transitions to higher levels of education. • Relevant existing programmes (not disability targeted) which are
Finally, Saran et al. (2020) conducted an EGM on interventions for being implemented by governments, disabled persons organisa-
people with disabilities in LMICs. Their EGM found that with regard to tions and non‐governmental organisations, should evaluate
education, few studies reported on the participation of children with whether they are effective in improving educational outcomes for
disabilities in formal education. The most commonly reported education people with disabilities.
outcome in their EGM was ‘social and life skills development’ with ef- • There should be a focus on interventions that not only improve
fects reported from health interventions (rehabilitation and promotion), individual skills but also address broader issues such as attend-
as well as early child development, and non‐formal education. Our ance, enrolment, completion, and transition to higher levels of
findings differed in this respect, but this difference is largely due to the education.
inclusion and exclusion criteria employed in our systematic review as
compared to the EGM. We excluded certain studies where the inter-
vention and outcomes lacked a clear education focus, and so the reha- 7.2 | Implications for research
bilitation interventions and social skills development outcomes included
under education in White et al.'s EGM were excluded here and are • There is a need for more research in underrepresented regions and
instead dealt with in two other systematic reviews on health outcomes settings, such as Latin America and the Caribbean, rural areas and
HUNT ET AL. | 39 of 43

humanitarian contexts, to address the current gaps in the Exte rnal sourc es
literature. This systematic review is supported by the UK Department of
• Studies should focus on a broader range of outcomes, including International Development (DFID) under its support for the Centre
qualifications gained, transition to higher levels of education, and for Excellence for Development Impact and Learning (CEDIL) and the
education‐related quality of life, to provide a fuller understanding Programme for Evidence to iNform Disability Action (PENDA).
of the impact of interventions.
• Research should explore the effectiveness of interventions that ORC I D
target system‐level changes, such as policy reforms and school Xanthe Hunt http://orcid.org/0000-0001-7531-6665
infrastructure improvements, to support inclusive education.
• Researchers should ensure comprehensive reporting of study details,
including participant characteristics, intervention components, and RE F ER EN CES
implementation fidelity, to facilitate replication and meta‐analyses.
• Interventions, where appropriate, also need to be evaluated in IN C L U D E D S TU D I E S
terms of outcomes such as qualifications gained and transition to Adnams, C. M., Sorour, P., Kalberg, W. O., Kodituwakku, P., Perold, M. D.,
higher levels of education. Kotze, A., September, S., Castle, B., Gossage, J., & May, P. A. (2007).
Language and literacy outcomes from a pilot intervention study for
• Impact evaluations need to be funded and undertaken on ‘what
children with fetal alcohol spectrum disorders in South Africa.
works to improve educational outcomes for people with dis- Alcohol, 41(6), 403–414.
abilities’. Studies conducted with larger samples of children are Akbari, E., Soltani‐Kouhbanani, S., & Khosrorad, R. (2019). The effective-
needed, as are those employing more rigorous study designs. The ness of working memory computer assisted program on executive
functions and reading progress of students with reading disability
use of standardised measures, where possible, would also benefit
disorder. Electronic Journal of General Medicine, 16(2), em123.
comparison between studies and across regions. https://www.ejgm.co.uk/download/the-effectiveness-of-working-
• Studies should consistently consider and report on a broad range of memory-computer-assisted-program-on-executive-functions-and-
characteristics and aspects of identity (e.g., gender, ethnicity) to reading-7526.pdf.
Altakhyneh, B. (2019). The impact of using Bruner's approach, supported
understand the differential impacts of interventions on male and
by Total Communication, on the mathematics achievement of stu-
female participants with disabilities or impact on different ethnicities. dents with hearing disabilities in Amman schools. International
Journal of Learning, Teaching and Educational Research, 18(12),
A C KN O W L E D G E ME N T S 63–78.
Awada, G. M., & Gutiérrez‐Colón, M. (2017). Effect of inclusion versus
This systematic review is supported by the UK Department of
segregation on reading comprehension of EFL learners with dyslexia:
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