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Sessions lasted approximately one hour and were audio recorded see Additional file 1 for the parent focus group schedule. Four groups were conducted with children with disability; one group with children with physical disability cerebral palsy , two groups with children with mild intellectual or developmental disabilities and one group with adolescents with vision impairment.
These focus groups were conducted at specialist schools. The sessions commenced with the children introducing themselves and sharing what physical activities they took part in. With the exception of one focus group that included children with vision impairment, a ball was passed between children to encourage everyone to speak, and to discourage more than one child speaking at once. Using their current activities as a reference point, the children were asked to share what made these activities fun and what made them hard.
Photographs of children with and without disability taking part in physical activities were also used to help stimulate discussion. These photographs were sourced from Google images and depicted a variety of physical activities including football, swimming, walking, cycling, basketball, horse riding, dancing, sailing, cricket, athletics, gymnastics, and skipping. The children were asked to select an activity depicted in one of the photographs that they had never done before but would like to try, as a way of exploring what some barriers to participation might be.
Data were transcribed verbatim and examined using thematic analysis [ 21 ]. Two researchers independently read the transcriptions several times and coded the data line-by-line to identify emerging concepts. These concepts were derived from the data and were not preconceived.
The number of concepts were not restricted and as many concepts were identified as they emerged [ 22 ]. These concepts eventually formed the themes that we present in the Results section. Each focus group was analysed separately to ensure the views of that particular focus group were considered. The data of each participant group i. After coding, through a consensus process, like concepts were grouped into sub-themes, and these were drawn together to form themes.
During these discussions, the researchers took into account if a theme or subtheme represented the views of all participant groups, and rich thick descriptions were used to exemplify sources. When the final list of themes was agreed, the transcripts were re-read and key word searches performed to ensure no relevant aspect of these themes had been overlooked.
Two main strategies were used to enhance the trustworthiness of the data [ 23 ]. When the initial data analysis was completed, the list of themes generated was sent to the participants for validation member checking. Through this process, the participants, including the children with disability, verified the interpretation of the data. Credibility of the data was enhanced by having two researchers independently code and interpret the data, providing a basis for reflective discussions which helped to provide a more complete understanding.
Sixty-three participants took part in ten focus groups see Table 1 : 23 children with disability mean age Four themes emerged from the data summarised in Table 2. Participants identified a number of barriers to participation that affect children with and without disability. These included children not being interested in physical activity, limited transport, cost and lack of time.
Participants described additional barriers that exist for children with disability, such as not being as physically capable as their peers and social barriers such as negative societal attitudes. Parents in particular identified that their child felt a sense of frustration or loss of confidence when they compared their skills with those of their peers with typical development. Participants described that it gets harder for children with disability to participate in physical activity as they get older, as the skill gap widens and sports become more competitive.
Parents shared stories of worsening teasing and exclusion by peers as their child aged and of an increasing lack of motivation to take part in physical activity as a result. Parents reported that children who were naturally active, loved sports and had a happy go lucky personality were more easily engaged in physical activity.
This was corroborated by the children with disability who described their reasons for participating were it was fun, it gave them a sense of success or competence, to keep fit, and to engage in activities with friends, or make new friends. While cost is barrier to participation in physical activity that affects children with and without disability, there was an additional burden for families of a child with disability given the extra expense of caring for a child with disability, a reduced income as parents often worked less and the need for one-on-one attention.
Flexible payment schemes, subsidised programs and access to modified equipment were suggested as ways to facilitate participation.
The attitudes of people close to children with disability such as families, instructors and peers, were seen as central to their participation in physical activity by all participant groups. Experience of disability was considered to underpin attitudes: when people understood disability they were more likely to be welcoming and supportive of children with disability.
This included providing financial support, transport, finding suitable activities and encouragement. Participants described how parents needed to be proactive to get their child active; examples included parents being physically involved in the activity, researching available activities, knowing about possible modifications to activities, and advocating for their child. Parents talked about how tough it can be caring for a child with disability.
This was illustrated by comments about their exhaustion and the challenge of finding time to fit physical activity into the family schedule. Other key personnel identified as facilitating participation in physical activity were coaches, instructors, and physical education teachers who were willing and able to modify activities.
Participants also articulated that peer involvement and acceptance were strong motivators for children with disability to participate. Many participants described negative societal attitudes towards disability as a barrier to participation. Participants suggested some sports and recreation staff and physical education teachers lacked experience in disability and were fearful about including children with disability, or viewed it as a low priority.
Similarly, participants described how the parents of children with typical development could be openly negative about their child playing with a child with disability. Inclusive policies and support from sports governing bodies and all levels of government were considered to drive physical activity opportunities for people with disability and facilitate their inclusion.
The role of schools in promoting physical activity was also discussed. Participants reported that some schools created opportunities for children with disability to be active and this facilitated their participation in physical activity in the wider community.
This feature was ascribed more often to special schools than mainstream schools. This theme was characterised by the idea that every child with disability was different, their particular needs were different and the type of activities that they and their family wanted to participate in were different. Children and parents suggested the best way for providers of physical activities to find out how to include a child with disability was to ask them.
Parents stressed the importance of careful selection of activities with recognition that not all activities could be modified and some were inherently unsuitable. Meaningful activity was described as mainstream, structured, competitive sports for some children with disability, and for others, it was simple non-competitive, segregated or individual activities.
I found that everyone in my team is really supportive and nice and they treat me normally, they all give me a turn …. Inclusive pathways with structured progression of participation were identified by sport and recreation industry personnel as being particularly important for children with disability. They described pathways as starting out in segregated classes, and progressing to individual activities, or social competitions and then moving on to mainstream or group activities or competitive sport.
Often, activity opportunities were one-off programs and did not provide a pathway to become sufficiently competent so that children could progress to the next level. A lack of opportunities for children with disability was cited as a major barrier to their participation.
Parents from regional and metropolitan areas reported marked variation in the availability of programs, and long waiting lists for segregated programs. Conversely, sport and recreation industry personnel discussed how programs were often not viable due to a lack of participants. Local activities, easily accessible by public transport, were cited as facilitators of participation.
Participants described a disconnect between families of children with disability, and the groups that promoted engagement in physical activity including schools, disability groups and the sport and recreation sector. Physical activity programs for children with disability were reported to be poorly advertised.
Parents talked about their difficulty in finding out about programs and how they relied on word of mouth and their own research to locate opportunities for their child.
Special schools were acknowledged to be a good source of information about available programs, unlike mainstream schools which were described as providing scant information. The problem with advertising was also raised by sport and recreation industry personnel who spoke about their difficultly in connecting with children with disability and their families.
Participants suggested partnerships between physical activity providers, local councils, schools, disability groups and the health sector could better facilitate physical activity among children with disability.
These partnerships could promote programs for children with disability, improve access to available opportunities, highlighted the importance of engagement in physical activity and help foster pathways between school and community sport. However, such partnerships were currently not widespread, particularly between the disability and sports sectors.
Our study adds to the available literature by exploring in more depth the facilitators of physical activity for children with disability, and by including the perspectives of sports and recreation industry personnel. The range and diversity of themes that emerged from the data illustrates the complexity of the issue, and is consistent with the conceptual model proposed by van der Ploeg [ 12 ] and with previous literature in both children [ 13 ] and adults [ 17 ] with disability.
Providing choice in physical activities children with disability can engage in was considered a key facilitator.
Choice included segregated or integrated programs, type of physical activity, the level of participation foundation skills to elite sports , individual or team sports, competitive or non-competitive activities, and the scheduling of programs. A complexity is that the needs of children with disability can change over time.
There is also tension between the ideal scenario providing meaningful choice and the reality that programmes have limited resources to accommodate choice.
Inclusive programs although more complex, might be more feasible, but may not be appropriate for every child with disability. However, there may not be a critical mass of children with disability living in an area to make a segregated program viable [ 24 , 25 ]. Competitive sport is not for every child, whether they have a disability or not, but there are few non-competitive programs available. However, although previous literature suggested competitive team sports can exclude children with disability [ 26 ], our results suggest competition was seen as a positive.
Another facilitator of physical activity proffered by the participants was the concept of inclusive pathways. An inclusive pathway would provide a structured means of skills development.
Having the requisite motor and social skills contributes to successful participation in physical activity among all children [ 25 ]. These skills are learnt through practice and early opportunities to develop them encourages participation by children especially when they experience success [ 25 ].
School is often where this practice happens. Unfortunately, children with disability do not always engage in physical education at school [ 27 , 28 ]. Children with disability may also have fewer opportunities for mastering skills outside of school [ 29 ] because they are either excluded from community programs or their parents may not enrol them [ 26 ]. This means children with disability are potentially missing out on a range of opportunities to develop the skills they require to engage in physical activity.
Inclusive pathways may also facilitate participation through better development of connections with stakeholders. A disconnect between stakeholders from the disability, sport and recreation, education, local government and health sectors, was identified as a key barrier to engaging children with disability in physical activity.
The perception of participants was that stakeholders operated independently without collaborating with each other and that no sector saw it as their responsibility to help engage children with disability in physical activity. This concept has not been explored much within the literature; one study including adults with disability reported a lack of collaboration between organisations as a barrier to physical activity [ 16 ] and one study suggested strong partnerships between relevant organisations as a facilitator of activity for children with disability [ 26 ].
Efforts to bring together stakeholders should be encouraged as it would help maximise expertise on disability issues, and could facilitate better activity opportunities for children with disability through the development of pathways.
Parents and families are crucial to whether a child with disability is physically active. A majority of parents understand the benefits of physical activity, and are happy for their child to be active [ 31 ]. Their main issue is how to make it happen so they can balance the needs of family members [ 32 ] and identify suitable programmes for their child [ 33 , 34 ].
Better marketing of physical activity opportunities for children with disability was one strategy parents felt could facilitate participation as most parents reported that word of mouth was their primary or only source of information [ 31 ]. Marketing could encourage participation by including information on program goals, skill levels, instruction, staffing, and transport [ 25 ].
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