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International Journal of Developmental Disabilities logoLink to International Journal of Developmental Disabilities
. 2025 Feb 5;72(2):386–395. doi: 10.1080/20473869.2025.2456776

Health literacy and eHealth literacy in caregivers of students with special education needs: a cross-sectional survey study

Berna Madalı-Kafes a, Şenay Burçin Alkan a, Serpil Kara b,✉, Berna Torun c, Hasan Hüseyin Kara a
PMCID: PMC13037136  PMID: 41923807

Abstract

Objectives

This study aims to assess the health literacy (HL) and electronic health literacy (e-HL) levels of the caregivers of students with special education needs (SEN) and to compare these levels with the caregivers of students who continue typically developing (TD) education.

Methods

The research was conducted on students with SEN and TD and their caregivers. HL and e-HL levels of the caregivers and sociodemographic characteristics were collected by face-to-face questionnaire. The HL and e-HL levels of caregivers were assessed with the Turkish Health Literacy Scale-32 and e-Health Literacy Scale, respectively.

Results

A total of 138 students and their caregivers, 71 of whom were in SEN and 67 in TD education, participated in the study. The literacy levels and economic status of the caregivers of students with SEN were lower compared to the caregivers of TD students. The HL and e-HL levels of the caregivers of students with SEN were significantly lower than the caregivers of TD students (p = 0.004 and p = 0.037, respectively). Based on the results of multiple regression analysis, it was found that sociodemographic characteristics had a 30% impact on HL (Model 1). For e-HL, the effect of health-related data from the internet was found to be 3.7%.

Conclusions

Caregivers of students with SEN demonstrated significantly lower HL and e-HL compared to caregivers of TD students. Developing targeted interventions and policies to enhance HL among caregivers of students with SEN is essential, along with a multidisciplinary approach to address this issue.

Keywords: Special education needs, intellectual disability, health literacy, e-health literacy, caregivers, student, parents, Down

Graphical abstract

graphic file with name YJDD_A_2456776_UF0001_C.jpg

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Introduction

Intellectual disability (ID) is a developmental condition characterized by significant limitations in both intellectual functioning and adaptive behavior, affecting conceptual, social, and practical skills. Individuals with ID, including those with Down syndrome, often face challenges in cognitive development, which impact their ability to learn and perform daily activities independently (Schalock, Luckasson, and Tasse 2021). Children with ID also encounter behavioral, oral, motor, and sensory difficulties that may affect daily activities and behaviors related to health status and well-being (Bandini et al. 2021). This situation causes a decrease in the capacity to adapt to social behaviors (Shahid, Law, and Verdezoto 2022). In addition, according to the literature, children with ID are at a heightened risk of poor dietary patterns and nutrient inadequacy, further complicating their overall health and development (Ranjan, Nasser, and Fisher 2018).

It is estimated that the number of people with disabilities in the world is approximately 978 million. It is known that 1%–3% of these individuals (approximately 200 million) have an ID. Because of the different definitions and different diagnostic criteria, it is difficult to determine the exact prevalence (U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion 2010). Similarly, the number of individuals with intellectual and developmental disabilities in Türkiye is not known clearly. These individuals need lifelong support. Children with ID attend to school for special education needs (SEN). However, parents are primarily responsible for the care of the individuals (Erickson and LeRoy 2015). Caregivers play a crucial role in the development of their children by participating in decision-making processes regarding treatment and working with health professionals (Jones and Reilly 2016; Puka et al. 2018). Caregivers should also be able to cope with the stress caused, to have control over drug treatment processes, to change their lifestyle, and to regulate their relations with their siblings (Hunter et al. 2019; Jones and Reilly 2016). Since mental and developmental deficiencies are not common in society, lack of knowledge about the disease can cause intense psychological pressure on caregivers and depression in caregivers (Jain, Thomasma, and Ragas 2002). In order to cope with such difficulties, caregivers should possess extensive knowledge, skills, and emotions (Puka et al. 2018; Tschamper et al. 2022). Otherwise, it might cause an increase in the developmental and behavioral problems of children with ID (Coren, Ramsbotham, and Gschwandtner 2018).

The caregivers of children with ID should have a certain level of health literacy (HL) in order to be able to provide the instructions given by the health professional, the drugs they need to use, and their medical care (Erickson and LeRoy 2015). The term ‘caregiver’ can be used with different meanings in the literature. Therefore, in this study, ‘caregiver’ was used to refer to the parents of the children (Given, Given, and Sherwood 2012).

HL is defined as the ability of individuals to access, understand, evaluate, remember, and apply health-related information. HL has been accepted as an important and changeable social determinant of health, and differences in HL might lead to inequality in access to health care (Batterham et al. 2016; Sørensen et al. 2015).

Inadequate HL might cause problems in the complex medical care of individuals with ID (Erickson and LeRoy 2015). Research indicates that caregivers’ HL levels significantly affect their capacity to navigate healthcare systems, interpret medical instructions, and engage in health-promoting behaviors (Krahn and Fox 2014). The challenges faced by caregivers with inadequate HL include difficulties in understanding treatment protocols and advocating for appropriate services, which can exacerbate health disparities experienced by children with ID (Rosenbaum and Blum 2015). In a study conducted in recent years to determine the HL of caregivers of patients with dementia, it was shown that the participants had difficulty in applying the instructions related to medical care, and 33% had an inadequate HL (Lindquist et al. 2011). It is known that caregivers or direct support personnel responsible for the care of children with ID do not have enough information about individuals with ID (Erickson and LeRoy 2015). Furthermore, promoting HL among caregivers is essential for empowering them to make informed health decisions and support their child’s well-being more effectively (Rimmer and Rowland 2008). Thus, targeted interventions to enhance caregivers’ HL are necessary to improve health outcomes for children with ID by addressing the informational and educational gaps that impact caregiving practices.

Technology has become indispensable in daily life. The society, including parents having children with SEN, uses technology more frequently and trusts the information they obtain from the digital environment. This is in line with the United Nations’ 2030 Sustainable Development Goals target of ‘a better future for all’. With the increasing use of technology, in order to improve the quality of life of children with ID, it has paved the way for the caregivers to easily access information about the disease and also to take necessary precautions (Agarwal Gupta and Kabra 2014; Garrison, Jeffries, and Christakis 2005).

Developing digital health technology offers effective solutions to the problems (Medlock et al. 2015). These technologies used in health aim to keep the cost under control as well as their effectiveness (Orhan and Kafes 2021). The internet provides users with access to a wide range of health-related information at low cost (Medlock et al. 2015). Digital resources provide information to individuals on different subjects, guiding individuals to take measures to protect and improve their health (Neter and Brainin 2012; Nguyen, Mosadeghi, and Almario 2017). However, especially in populations with lower education levels, the misunderstanding of the information accessed via the internet and the potential risks that might arise as a result of misapplications might increase. Therefore, it is very important to understand and apply the information obtained from the internet correctly (Czaja et al. 2006; Xie et al. 2022).

Electronic health literacy (e-HL) was first developed by Norman and Skinner in 2006 and was defined as the ability of individuals to search, access, understand, and evaluate health information from electronic sources and interpret this information when faced with a health problem (Norman and Skinner 2006). In this age, where individuals from various socioeconomic levels can easily access health information on the internet, it has become even more important to evaluate whether caregivers of children with ID could use this information correctly.

Very few studies have been conducted to determine the HL levels of individuals with ID, and those that exist remain largely theoretical (Chinn 2017; Geukes, Bröder, and Latteck 2019). In the literature reviews, no studies have been found that specifically investigate the HL levels of caregivers of children with intellectual disabilities. In a recent systematic review, it has been stated in the literature that there is a large gap in this area (Turnbull et al. 2023). The aim of this study is to evaluate the HL and e-HL levels of caregivers of students with SEN and to compare these levels with the caregivers of typically developing (TD) students. In this study, the following questions were addressed: (a) Is there a difference in HL levels between caregivers of children with SEN and those of TD children? (b) Is there a difference in e-HL levels between caregivers of SEN and TD children? (c) To what extent do sociodemographic characteristics impact HL and e-HL?

Methods

Participants

This research was designed as a cross-sectional study. The study was carried out in a special education practice school located in Karatay district in Konya. This school is the only institution in Konya that provides education at the moderate and severe ID. Given that numerous studies have shown that economic status significantly impacts HL, other schools in the same district providing TD education and with similar economic status were also included in the study. Inclusion criteria were defined as follows: For the SEN group, participants were caregivers of children aged ≥7 years with a diagnosis of moderate to severe developmental or intellectual disability. For the TD group, participants were parents of children aged 7–18 years with no psychiatric diagnoses. Individuals who declined to provide informed consent or chose to withdraw at any stage of the study were excluded from the analysis.

The sample size was calculated using G*Power 3.1.9.2 computer program by considering the study by O. J. Lindly et al. (2022). In the study, it was determined that 69.4% of families of children with autism had adequate HL, while 30.6% had insufficient HL. Considering that the number of samples would be equal in the SEN and the TD groups, it was determined that both groups should consist of at least 60 individuals at α = 0.05 and 0.80 power (Faul et al. 2007).

Data collection measures

Information about students was collected from their caregivers by researchers using face-to-face and questionnaire at school between March and December 2022. The questionnaire, consisting of 32 questions, which includes information such as sociodemographic characteristics, gender, age, health status, income, educational status, any physiological condition that may affect nutrition, etc., was asked to the caregivers. The questionnaire was completed in approximately 30 min. A total of 138 students and their caregivers, 71 of whom were with SEN and 67 from TD education, participated in the research. Among students with SEN, 39.4% were girls and 60.6% were boys. On the other hand, 44.8% of TD students were girls and 55.2% were boys. Most of the students in both groups were in primary and high school. The three most common diseases in students with SEN were intellectual disability (83.2%), Down syndrome (5.6%), and autism (5.6%). The majority of the students with SEN (82.6%) were receiving rehabilitation (Table 1).

Table 1.

Comparison of demographic characteristics between caregivers of students with SEN and those of TD students.

  Students with SEN (n: 71) TD students (n: 67) χ² p
  n (%) n (%)
Participants’ characteristics        
Educational status of the mother
 Never went to school 13 (18.3)a 3 (4.5)b 12.015 0.035 a
 Primary school 37 (52.1) 32 (47.8)
 Middle school 11 (15.5) 14 (20.9)
 High school 7 (9.9) 9 (13.4)
 University 3 (4.2) 7 (10.4)
 Master — 2 (3.0)
Educational status of the father        
 Never went to school 6 (8.7) 1 (1.5) 8.826 0.116a
 Primary school 30 (43.5) 26 (39.4)
 Middle school 14 (20.3) 10 (15.2)
 High school 11 (15.9) 13 (19.7)
 University 7 (10.1) 11 (16.7)
 Master 1 (1.4) 5 (7.6)
Employment status of mother        
 Working 6 (8.5)a 15 (24.5)a 11.981 0.001 a
 Not working 57 (80.3) 52 (77.2)
 Missed 8 (11.3) —
Employment status of father        
 Working 40 (56.3)a 61 (91.0)b 21.478 <0.001 a
 Not working 21 (29.6)a 5 (7.5)b
 Missed 10 (14.1) 1 (1.5)
Economic status of the family        
 Very good — 1 (1.5) 11.602 0.009 a
 Good 11 (15.5)a 21 (31.3)b
 Middle 41 (57.7) 39 (58.2)
 Low 19 (26.8)a 6 (9.0)b
Social security        
 Social security system 38 (55.9) 47 (71.2) 11.532 0.009 a
 Insuranced self-employed institution 9 (13.2) 13 (19.7)
 Special insurance 2 (2.9) —
 None 19 (27.9)a 6 (9.1)b
Health information resource        
 Internet 16 (23.2) 9 (13.6) 6.081 0.048 a
 Television — —
 Health-related magazine — —
 Family/friend 9 (13.0) 3 (4.5)
 Health professionals 44 (63.8)a 54 (81.8)b
Frequency of internet use        
 Always 3 (4.4) 8 (11.9) 8.783 0.067a
 Often 11 (16.2) 9 (13.4)
 Sometimes 35 (51.5) 25 (37.3)
 Rarely 10 (14.7) 20 (29.9)
 Never
 9 (13.2)
 5 (7.5)
  
  
Students’ characteristics
 
  
  
  
Age (mean ± SD) 14.6 ± 0.6
 12.7 ± 0.4
  
  
 
 n (%)
n (%)
 
  
Gender        
 Girl 28 (39.4) 30 (44.8) 0.403 0.525b
 Boy 43 (60.6) 37 (55.2)
Education grade        
 Primary school 27 (38.0) 26 (38.8)    
 Secondary school 14 (19.7) 13 (19.4) 0.009 0.996b
 High school 30 (42.3) 28 (41.8)    
Disability of students with SEN        
 Down syndrome 4 (5.6) —    
 Autism 4 (5.6) —    
 Hyperactive 1 (1.4) —    
 Intellectual disability 59 (83.2) —    
 Cerebral palsy 3 (4.2) —    
Rehabilitation status        
 Yes 57 (82.6) —    
 No 12 (17.3) 67 (100)    
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a

Fisher’s exact test.

b

Pearson chi-square test.

The values presented in bold are statistically significant.

The HL of caregivers was evaluated using the Turkish HL Scale-32 conducted by the Ministry of Health in 2016 (Okyay and Abacıgil 2016). There are 32 questions in total in this scale, and caregivers were asked to answer questions on HL as ‘very easy, easy, difficult, very difficult and no idea’. The scale is scored between 0 and 50 points. Those who scored 0–25 were evaluated as insufficient HL, between 25 and 33 points as problematic-limited HL, between 33 and 42 points as adequate HL and between 42 and 50 points as excellent HL. The e-HL levels of the caregivers were determined by using a questionnaire with 10 questions developed by Norman and Skinner (2006) and a Turkish validity and reliability study for adults conducted by Gencer (2017). While two of the questions in the survey are for individuals’ internet use, the remaining eight questions are for evaluating e-HL. A minimum of 8 points and a maximum of 40 points can be obtained from the scale. Individuals who score between 8 and 26 at the end of the scale are considered to have low e-HL, while individuals who score between 26 and 40 are interpreted as having high e-HL.

Ethical considerations

The permissions for the study were obtained from the Necmettin Erbakan University Health Sciences Scientific Research Ethics Board with the decision dated 02.03.2022 and numbered 2022/20-166. The participants were first given information about the research, and they were included in the study if they volunteered to participate in the research and signed the written consent form. The research was conducted in accordance with the Declaration of Helsinki, and research and publication ethics were followed.

Data analysis

The data obtained from the research were evaluated with the SPSS 22.0 program. The mean, standard deviation, minimum and maximum values of the quantitative data were calculated, and the number and percentage tables of the qualitative data were made. The general characteristics of caregivers, and HL and e-HL levels of caregivers were compared by using chi-square tests (Pearson’s chi-square test or Fisher’s exact test). In the study, multiple linear regression analysis was used to determine the predictive ability of sociodemographic, and health information resources, which were determinants of HL and e-HL levels of caregivers. The results were evaluated within the 95% confidence interval. In the assessment of HL and e-HL levels, 12.7% of surveys (caregivers of the students with SEN) were excluded from analysis due to missing values.

Results

The majority of the caregivers of the students participating in the study had a high school or below. In this study, it was reported that all students with SEN live with their families, and the primary caregivers responsible for their care are their mothers and fathers. The rate of mothers who had children with SEN who have never been to school (18.3%) was significantly higher than the rate of TD students (4.5%) (p = 0.035). The working status of the mother and father of the students with SEN was significantly lower than TD group (p < 0.001). The rate of caregivers whose children with SEN has a low economic status (26.8%) was significantly higher than the rate of TD group (9.0%) (p = 0.009). Similarly, the rate of caregivers of students with SEN who did not receive social support (27.9%) was significantly higher than TD group (9.1%) (p = 0.009). Approximately 81.8% of caregivers of TD students received information about health from health professionals. This rate was 63.8% and significantly lower in caregivers of children with SEN (p = 0.048). Most of the caregivers in both groups used the internet. The proportion of caregivers who received information about health from the internet was higher in the SEN group (23.2%) than in the TD group (13.6%), but no significant difference was found (Table 1).

The health literacy levels of caregivers were evaluated using the Turkish HL Scale-32 and the e-HL Scale. Caregivers of students with SEN had significantly lower levels of HL and e-HL compared to caregivers of TD students (HL 2.63 ± 0.68 and 2.96 ± 0.51; e-HL 25.1 ± 7.12 and 27.7 ± 5.90, respectively). The rate sufficient HL (11.3%) of the caregivers of students with SEN was significantly lower than TD group (31.3%) (p = 0.004). Similarly, the rate of caregivers with a high e-HL (46.4%) of students with SEN was significantly lower than the rate of TD group (64.2%; p = 0.037) (Table 2).

Table 2.

Health literacy and e-health literacy levels of caregivers.

  Students with SEN TD students χ²/ Test value p
  n (%) n (%)
Health literacy levels n = 62 n = 67    
 Insufficient 24 (38.7)a 11 (16.4)b
13.341
0.004 a
 Problematic-limited 26 (41.9) 25 (37.3)
 Adequate 7 (11.3)a 21 (31.3)b
 Excellent 5 (8.1) 10 (14.9)
Score of Turkish HL Scale-32 (X̅±SD) 2.63 ± 0.68 2.96 ± 0.51 −3.088 0.003 b
e-health literacy levels n = 69 n = 67    
 Low 37 (53.6)a 24 (35.8)b 4.355 0.037 a
 High 32 (46.4)a 43 (64.2)b
Score of e-HL Scale (X̅±SD) 25.1 ± 7.12 27.7 ± 5.90 −2.277 0.024 b
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a

Pearson’s chi-square test.

b

Student’s t test.

The values presented in bold are statistically significant.

In Table 3, the determinants of HL scores were evaluated using the multiple regression analysis. In Model 1, sociodemographic variables were investigated, and it was found that SEN (β = 0.232) and social security (β = 0.413) affected the HL scores. In Table 4, it was determined that health-related data from the internet affected the e-HL scores (β= −0.192).

Table 3.

Determinants of HL scores.

  β t p
HL
Model 1—Sociodemographic variables
Constant   6.731 <0.001
Special education needs (0 = Yes, 1= No) 0.232 2.043 0.045
Social security (0= No, 1= Yes) 0.413 3.626 0.001
Model 1 R = 0.548 Adjusted R2= 0.300 F = 13.699, p < 0.001
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Table 4.

Determinants of e-HL scores.

  β t P
e-HL      
Model 1—Health information resource
Constant   22.609 <0.001
Internet (0 = Yes, 1 = No) −0.192 −2.250 0.026
Model 1 R = 0.192 Adjusted R2= 0.037 F = 5.064, p < 0.026
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Discussion

As far as we know, this study is the first to evaluate the HL and e-HL of caregivers of children with SEN. The findings indicate that the HL and e-HL levels of caregivers of children with SEN were significantly lower than the caregivers of children with TD. Furthermore, the study revealed that the general literacy and education levels of caregivers of children with SEN were also low.

In this study, students with SEN and TD students were selected from schools in the same district. However, it was determined that some of the sociodemographic characteristics of the students were statistically different (Table 1). The rate of mothers whose children with SEN never went to school (18.3%) is significantly higher than the rate of TD students (4.5%). Studies have shown that the responsibility of care for the child generally belongs to the mother (Şimşek et al. 2014). The educational status of the mother is closely related to the accessibility and usability of health services, and therefore to child health (Paul et al. 2022). In this study, the working rate of the caregivers of the students with SEN was found to be significantly lower than in TD students (Table 1). Studies in the literature have also shown that the working status of caregivers with children with ID, especially mothers, is lower (H. Bourke‐Taylor, Howie, and Law 2011; Chou, Kröger, and Pu 2018).

The lower working rate of mothers and fathers directly affects the family’s economic and social support. In caregivers of children with SEN, the rate of those with low economic status and those without any social support was found to be significantly higher (Table 1). Keskinova, Cicevska-Jovanova, and Ajdinski (2013) showed that the socioeconomic level of families with mentally retarded children (n:108) is low.

In this study, 82.6% of students with SEN received rehabilitation. However, the therapist’s suggestions and instructions (e.g. home exercise, etc.) must be followed completely and accurately in order to make the effective rehabilitation and to achieve its purpose. This is closely related to the HL level of the caregivers. Studies have reported that individuals with a low level of HL may have difficulty in understanding the instructions of health professionals, and their health status and quality of life might be worse (Berkman et al. 2011; Jayasinghe et al. 2016).

The rate of caregivers of children with SEN (63.8%) who received health-related information from healthcare professionals was significantly lower compared to caregivers of TD children (81.8%) (Table 1). This result could be associated with the lack of social support and low socioeconomic status. The fact that individuals without social support apply less to the hospital might limit their access to information from healthcare professionals. Therefore, they tend to refer to other sources (internet, television, etc.) to get information about health.

In the literature, there are a very limited number of studies investigating the level of HL for caregivers of children with ID. According to the Turkish HL Scale-32, the rate of caregivers whose children with SEN has a sufficient level of HL (11.3%) is significantly lower than the rate of the TD group (31.3%) (Table 2). In studies conducted with the population in Türkiye, the rate of individuals with sufficient HL level was found to be between 16.4% and 35.6% (Aygun and Cerim 2021; Turkish Health and Social Workers Union 2015). Among children with cerebral palsy receiving rehabilitation at a private center in Türkiye, only 36.0% of their caregivers were found to have adequate to excellent HL (Halatcı, Demirköse, and İlhan 2020). The rate of all caregivers with adequate-perfect HL was 19.4% in our study (Table 2). O. Lindly et al. (2020) emphasized that parental HL is a changeable factor associated with health in children with developmental disabilities, but studies are limited.

With the rapid expansion of the internet, individuals increasingly rely on it as a primary source of accessible health information (Wang, Wu, and Qi 2021). This study found that most caregivers in both groups use the internet for health information, with a slightly higher—but not significantly different—rate among caregivers of students with SEN compared to TD students (Table 1). Caregivers of students with SEN have a greater need to seek health information (Knapp et al. 2011), often turning to digital platforms due to perceived inadequacies in health system support (Gruebner et al. 2022).

Caregivers increasingly prefer the internet for health information given its convenience, speed, and cost-efficiency. However, digital barriers and limited HL can hinder effective access and use of this information (H. Y. Lee, Jin, et al. 2021). Accessing health information online requires digital literacy and the ability to critically read, comprehend, and evaluate such information (J. Lee, Lee, and Chae 2021). In this study, the rate of caregivers with high e-HL levels was significantly lower in the SEN group than in the TD group (Table 3). Few studies have assessed the e-HL levels of caregivers of students with SEN. Knapp et al. (2011) found that half of caregivers of children with SEN are confident in using information accessed online to make health decisions.

The findings indicated that SEN and social security impacted the HL scores of caregivers (Table 3). Considering that the HL of caregivers are closely related to the health status of children, HL issues should be included in the education curriculum. In order to increase the level of HL in the society, it is important to inform the population about how to access accurate health information, to prepare policies, and to update the information given to patients in order to make it easier to understand (Avcı and Özkan 2020; H. M. Bourke-Taylor, Jane, and Peat 2019).

There are several limitations of this study. Voluntary participation might lead to bias. And the results cannot be generalized to all students with SEN because in this study the majority of students with SEN had mental retardation.

At the end of the study, the HL of the caregivers of students with SEN was lower than the caregivers of TD students. Apart from HL, general literacy and education levels of caregivers were also lower. It has been found in the study that caregivers of TD students obtain health-related information from the internet more often than from health professionals, in relation to the general education level and low HL level. It was found that the e-HL levels of the caregivers were also low. It was determined that health-related data from the internet affected the e-HL scores (Table 4). Considering that they prefer to access health-related information from the internet despite their low ability to correctly understand and effectively apply the information obtained from the internet, the concern of poor health outcomes increases.

Conclusion and recommendation

In conclusion, it is essential that caregivers of children with SEN receive periodic education to enhance their HL, provided by experts in the field. Considering the generally lower educational levels of these families, as revealed by the study’s findings, it is crucial to develop policies aimed at increasing caregivers’ awareness. Furthermore, support should be extended to families regarding other health determinants, and a multidisciplinary approach involving dietitians, psychologists, and physiotherapists should be fostered to work with both caregivers and children. It is also recommended that, at the national level, policies and plans should be developed not only for schools but also for home-based interventions, with regular assessments and follow-ups on children’s development conducted by specialists.

Acknowledgments

We would like to thank the teachers, auxiliary staff, administrators of the schools where the study was conducted and Konya Provincial Directorate of National Education. We would also like to thank Necmettin Erbakan University Scientific Research Commission for project support.

Glossary

Abbreviations

HL

Health Literacy

SEN

Special Education Needs

e-HL

Electronic Health Literacy

TD

Typically Developing

ID

Intellectual Disability

Funding Statement

We would like to thank Necmettin Erbakan University’s Scientific Research Commission for its financial support, project No: 221230004.

Author contributions

Conceptualization: H. H. Kara. Methodology: H. H. Kara, B. Madalı-Kafes, Ş. B. Alkan. Funding acquisition: B. Madalı-Kafes. Software: Ş. B. Alkan, B. Madalı-Kafes, S. Kara. Validation: all authors. Formal analysis: B. Madalı-Kafes, Ş. B. Alkan. Investigation: Ş. B. Alkan, B. Madalı-Kafes, B. Torun. Resources: all authors.

Ethics statement

The permissions for the study were obtained from the Necmettin Erbakan University Health Sciences Scientific Research Ethics Board with the decision dated 02.03.2022 and numbered 2022/20-166.

Disclosure statement

No potential conflict of interest was reported by the authors. No prior presentation of abstracts at meetings regarding the research.

Data availability statement

The datasets of the current study are available from the corresponding author on reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The datasets of the current study are available from the corresponding author on reasonable request.

Articles from International Journal of Developmental Disabilities are provided here courtesy of The British Society of Developmental Disabilities

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