Coping Strategies as Predictors of Mental Well-Being Among Children with Physical Disabilities in Inclusive Government Primary Schools in Kamuli District, Uganda

Abstract

Background: The mental well-being of Children with Physical Disabilities (CwPDs) in low-resource, inclusive educational settings is critically under-researched. In Uganda's Kamuli District, these children navigate a complex ecosystem of distress marked by stigma, derogatory labelling, cultural misconceptions, and systemic barriers that threaten their psychosocial health. Objective: This study examines the multi-level predictors of mental well-being among CwPDs, focusing on the dynamic interplay between child-level coping strategies and the school's supportive ecosystem. Methods: A concurrent mixed-methods design was employed, though dominantly qualitative. Data were collected through in-depth semi-structured interviews with a purposive sample of 22 CwPDs (ages 7-15) and 68 key informants (teachers, counsellors, parents, community members; total n = 90) across 12 inclusive government primary schools. A hybrid inductive-deductive thematic analysis was conducted. Findings: Mental well-being is dynamically predicted by a transactional relationship between individual agency and environmental support. Notably, adaptive child-level strategies, positive reframing/acceptance, social integration and play, academic engagement, and help-seeking were the strongest predictors of positive outcomes, including self-discovery, emotional stability, and school attendance. Conversely, isolation and withdrawal predicted poorer mental well-being among CwPDs. The efficacy of these strategies was contingent upon a robust eco-systemic support buffer comprising teacher-mediated counselling, flexible pedagogy, peer sensitisation, parental advocacy, and structural safeguards (ramps, latrines). However, this ecosystem's effectiveness is severely undermined by a critical shortage of trained teachers, pervasive resource constraints, harmful cultural beliefs, and inadequate policy implementation. Conclusion: Mental well-being for CwPDs is not an absence of disability but an outcome actively co-constructed by the child’s coping strategies and an environment that enables them. Consequently, inclusive education policy must move beyond physical integration to invest decisively in multi-level interventions such as strengthening anti-stigma campaigns, pre- and in-service teacher training, sustainable resource allocation, and community-school partnerships to foster resilient, coping-enabling environments.