Child and youth participation in leisure activities: Does the environment make a difference?
Take Home Messages
- The environment plays an important role in determining how children and youth are able to participate in leisure activities.
- Clinicians can redirect attention towards specific aspects of the environment that influence participation.
- Partnering with policy-makers to remove environmental barriers is a necessary strategy toward building more inclusive communities.
What is the purpose of this Keeping Current?
In this Keeping Current, we explore the impact of the environment on the participation of children and youth who are living with a disability. We will summarize the research that has been done in this area, with a focus on participation in after school community-based activities; integrate the findings from different research studies; and identify a range of environmental supports for and barriers to children’s participation.
Participation – Definition and benefits
Participation is defined by the World Health Organization as “involvement in life situations”. 1 In their communities, children and youth take part in a wide range of activities, such as playing games and team sports, joining a youth group, or going to the movies with friends. Participation in these types of activities plays a key role in a child’s development. 2,3 Children and youth with disabilities; however, are often more restricted in their participation than are their typically developing peers. 4-6 Factors such as presence of other health conditions, abilities, skills and preferences may influence participation; however, the environment also plays a unique role.1,7
The environment – What does it include and why is it important?
When considering the environment, the first thing that usually comes to mind is the physical environment (e.g., the presence of elevators and ramps, access to buildings and public transportation). However, a person’s environment includes many other components, such as the social environment (e.g., family and peer support), attitudes of others, and institutional policies (e.g., availability and cost of programs, waiting time).
In many situations, especially those involving children with lifelong health conditions, changing the environment can be a much more practical way to enable participation than trying to change the child’s physical characteristics and/or abilities. As such, the environment is recognized as an important area of focus for families, researchers and clinicians.
How did we search for evidence?
A scoping review method was used to search for research studies published between 1990 and 2011. Scoping reviews aim to answer broad research questions and are guided by a specific procedure. We used a variety of databases (e.g., CINAHL, MEDLINE) and included studies that focused on participation in out-of-school activities among children and youth (age 5 to 21) who are living with any type of disability. We included only studies that tested the relationship between the environment and participation. Broad keywords were used to capture concepts of ‘participation’ (e.g., extracurricular activities, leisure, and play) and ‘environment’ (e.g., community, neighborhood, access, and built environment). A list of over 40 types of health conditions was used to capture a wide range of disabilities. A full description of the scoping review methods and results is available in the article written by Anaby and colleagues. 8
What did we find?
About the research studies:
The initial search using the selected keywords found a total of 1232 research articles. 31 of these studies met the inclusion criteria. The main reason that articles were excluded is that they did not address participation and environment together.
The majority of the studies:
- were quantitative in nature (55%), although there were a considerable number of qualitative studies (32%), primarily in the early stages of research,
- focused on children with a physical disability (74%), with Cerebral Palsy being the most frequent diagnosis, and
- addressed the 5 to 14 year old age group, with less attention on older adolescents and young adults.
About environmental supports and barriers:
All domains of the environment, as suggested by the International Classification of Functioning, Disability and Health (ICF), had an impact on children’s participation as a support and/or barrier. Table 1 provides examples of the most common environmental supports and barriers to children’s participation as identified through the research studies we reviewed. The supports and barriers are grouped according to the environmental domains listed in the ICF. Barriers within the Attitudinal domain were observed most often, while the most common supports were found within the Social Support and Relationships domain.
Table 1: Summary of the most common environmental supports and barriers to children’s participation
Examples of Common Supports
Examples of Common Barriers
- Positive attitudes of others in the community9
- Positive family values and preferences for recreation10
- Negative attitudes (e.g., stigma and bullying) restrict participation and/or lead to changes in choice of activities9,11-13
Social Support and Relationships
- Family support, particularly parent involvement (e.g., arranging play dates) and parent support for participation10,14
- Emotional and physical support from peers and classmates10,15
- Parental overprotectiveness14
- Parental stress16
- Lack of support from service providers in terms of personal assistance and information12,13
- Accessible physical environment (e.g., availability of adapted toilets, transportation and playgrounds)17,18
- Lack of physical accessibility (e.g., non-accessible buildings or public transport)10,11,19
- Lack of equipment11
Institutional (Services, Systems and Policies)
- Availability of inclusive educational programs and community recreational activities20,21
- Parental education about home and community-based recreation programs21
- Lack of community programs14,19
- Limited access to information about programs9,13
- Bureaucracy within the system9
- Segregation of children with and without disabilities11
- Ability to afford programs9
- Non-inclusive policies12,19
An additional barrier discussed in the literature is the time families need to plan for participation and navigate the environment. Both parents and adolescents have identified that extra time is needed to plan ahead in order to address environmental barriers and that they generally do not have the time available to do this planning. 17,22
- Although the majority of studies focused on youth with physical disabilities, the physical environment was not the most common barrier to participation; attitudes were.
- Barriers and supports were not necessarily opposite ideas. The same environmental factor (e.g., physical accessibility) can be experienced as a barrier to participation for one person and a support to participation for another.
- Access to useful information is lacking; practitioners should focus on making information more accessible, as well as providing education for parents and caregivers.
- Additional time and planning ahead is important for successful participation - interventions should focus on time management, family routine and habits in order to compensate for the varied pace the children and youth experience.
Research gaps – what don’t we know?
- Evidence about the effect of the environment on participation is mostly focused on children with physical disabilities, particularly Cerebral Palsy. More studies are needed involving children and youth with a range of health conditions (e.g., Autism Spectrum Disorder, vision disorders) and in different age groups (e.g., adolescents and young adults).
- Most of the studies examined the relationship between participation and the environment, so no ‘cause and effect’ conclusions can be made. Developing intervention studies and following participation over a longer time period will help us better understand how to enhance participation.
What can be done within the environment to improve child and youth participation?
- Information about programs and services can be made more accessible for parents and youth.
- On-going education about the impact of the environment on child and youth participation can assist all knowledge-users, including parents, clinicians, program managers and decision makers.
- Clinicians, such as occupational therapists and physiotherapists, can provide parents with information about useful strategies for using supports, removing barriers and advocating for better accessibility in their community.
- Clinicians can ask about family routines, habits and time-management, and suggest strategies to facilitate participation.
- Special attention can be directed to changing negative attitudes and enhancing social supports, the two leading environmental factors in determining participation.
- Policy-makers can promote participation-based communities. Ways to do this include: promoting ‘universal design’ public spaces; making information about resources, services and rights more accessible; and addressing the value of inclusion and full participation.
For more information, please contact Dana Anaby at firstname.lastname@example.org