Abstract
Background: Involvement in leisure activities is crucial for the physical, social and psychological development and wellbeing of children with movement impairments. However, children with movement impairments are at risk for restricted access to participation in leisure activities. The aim of this thesis was to investigate the leisure participation patterns and experiences of children with movement impairments in New Zealand (NZ).
Methods: The thesis includes three separate but linked studies. First, an integrative review of the literature investigated the relationship between motor functioning and leisure participation of children with movement impairments. Then a mixed method approach with two studies was conducted to understand leisure participation of children in the NZ context. The two studies were a quantitative survey study and a qualitative interview study.
For the integrative review, a systematic electronic search of key databases was conducted from the period 1 January 2001 to 30 April 2014 using relevant keywords to identify studies that investigated leisure participation and motor functioning in children with movement impairments aged 6 to 12 years. The review synthesized, and compared information from qualitative and quantitative studies to identify the extent, and way by which, motor functioning influences leisure participation.
A national cross-sectional survey with postal questionnaires investigated the extent, pattern, and barriers to leisure participation of children with movement impairments aged 6 to 12 years in NZ. The questionnaires used were the ‘Children’s Assessment of Participation and Enjoyment (CAPE)’ to assess the level and pattern of leisure participation, the ‘Activity Scale for Kids (ASK)’ for measuring the level of physical functioning of children, the ‘Craig Hospital Inventory of Environmental Factors (CHIEF) for Children-Parent Version’ to investigate the perceived environmental barriers and the ‘Family Environment Scale (FES)’ to measure family functioning.
Following the survey study, individual interviews with children and their parents explored in depth the leisure participation experiences of children with movement impairments. Interpretative Phenomenological Analysis (IPA) was used to understand the experiences and the children’s perceived sense of their experience, both of which could be dependent on contextual factors. Child friendly methods of data collection were used in interviews. Children expressed their views through drawing, painting, using stickers, sharing pictures, demonstrating activities, and by showing the interviewer their leisure environment and equipment. Further, field notes made at the time of the interview, and email conversations with children and/or families were used to describe and interpret the experiences of the children who participated in the study.
The quantitative and qualitative data were first analysed independently, with the findings then integrated to enlighten understanding of the leisure participation patterns in general and in depth experiences of children with movement impairments in NZ.
Results: Thirty-five studies were included and analyzed for the integrative review. Twenty-four studies used quantitative and 11 studies used qualitative methodology. The review identified the relationship between motor functioning and six dimensions of leisure participation including diversity, intensity, context, preferences, enjoyment and quality of participation. Motor functioning was found to have a weak to moderate association with involvement in specific leisure activity types and dimensions such as the frequency and diversity of physical activities.
The CAPE identified that children participated in an average of 31 out of 55 activities listed in this questionnaire. Children participated in a greater number and frequency of recreational, social, and self-improvement activities as compared to skill-based and physical activities. Further, girls participated in a greater percentage of activities as compared to boys. While nearly 50% of activities were performed with family, only 13% of activities were performed with friends. Nearly 50% of activities were performed at home and 50% of activities outside home.
With the help of families, children participated in leisure activities of their choice and expressed positive experience of fun, challenge, and independence and achievement. The choice of activities depended on a combination of the motor functioning of the individual child, inspiration, and support from families, friends and health professionals, as well as the child’s age, sex and the possibility of adaptations and availability of community programmes. Participation in the activities of choice was often with friends of their choice and in a place of their choice. Children followed a leisure participation routine that consisted of scheduled and unscheduled activities. Yet, despite such positive aspects to their participation, children felt disappointed and avoided some activities due to associated negative experience such as injury, fear, non-inclusion, and the difficulty they had experienced in adapting and performing certain activities.
While the majority of children reported that nothing stopped them having fun, parents believed that their children’s leisure participation could be better and expressed their concerns. For parents, the most common barrier (perceived by 80%) included the natural environment such as uneven terrain, inaccessible architecture, and weather. Further, 76% reported others’ attitude resulting in humiliation as barriers to children’s participation in leisure activities. Sixty one percent of parents also reported lack of programmes such as adapted inclusive sports and games in the community and that this resulted in the lack of opportunities for activity involvement in the community. They also reported that information regarding these activities were somewhat lacking and therefore of concern. Additionally, older children were more aware of their movement limitations and therefore were more careful in choosing their activities, while younger children were less aware and were happy with activities carefully chosen by the family.
Conclusion: The integrative review demonstrated that motor functioning of children with movement impairments may or may not be a barrier depending on the functional movements required to participate in a particular leisure activity.
Children with movement impairments in this thesis participated in a wide range of activities and enjoyed activities of their choice. Families played a major role in supporting children’s involvement in leisure activities. However, reduced frequency of participation in physical activities, as opposed to recreational, social and self-improvement activities requires further research with a focus of enhancing and promoting the physical activity levels of children with movement impairments in NZ. Families, therapists, and community service providers such as disability organisations could enhance leisure participation experiences by suggesting and creating opportunities that could increase children’s choices of leisure activities in general, and physical activities and skill-based activities in particular.