A realist evaluation of a physical activity participation intervention for children and youth with disabilities: what works, for whom, in what circumstances, and how?

Abstract

BackgroundThe need to identify strategies that facilitate involvement in physical activity for children and youth with disabilities is recognised as an urgent priority. This study aimed to describe the association between context, mechanisms and outcome(s) of a participation-focused physical activity intervention to understand what works, in what conditions, and how.MethodsThis study was designed as a realist evaluation. Participant recruitment occurred through purposive and theoretical sampling of children and parents participating in the Local Environment Model intervention at Beitostolen Healthsports Centre in Norway. Ethnographic methods comprising participant observation, interviews, and focus groups were employed over 15 weeks in the field. Data analysis was completed using the context-mechanism-outcome framework of realist evaluation. Context-mechanism-outcome connections were generated empirically from the data to create a model to indicate how the program activated mechanisms within the program context, to enable participation in physical activity.ResultsThirty one children with a range of disabilities (mean age 12y 6 m (SD 2y 2 m); 18 males) and their parents (n = 44; 26 mothers and 18 fathers) participated in the study. Following data synthesis, a refined program theory comprising four context themes, five mechanisms, and six outcomes, were identified. The mechanisms (choice, fun, friends, specialised health professionals, and time) were activated in a context that was safe, social, learning-based and family-centred, to elicit outcomes across all levels of the International Classification of Functioning, Disability and Health.ConclusionsThe interaction of mechanisms and context as a whole facilitated meaningful outcomes for children and youth with disabilities, and their parents. Whilst optimising participation in physical activity is a primary outcome of the Local Environment Model, the refined program theory suggests the participation-focused approach may act as a catalyst to promote a range of outcomes. Findings from this study may inform future interventions attempting to enable participation in physical activity for children and youth with disabilities.

Promoting Factors for Physical Activity in Children with Asthma Explored through Concept Mapping

“…The result regarding the factor fun was comparable to the results of Noonan et al (2016) who showed that 10–11-year-old primary school children indicated the factors fun, enjoyment, competence, and PA provision as important for their (out-of-school) PA participation [22]. The factors regarding playing together and motivation and stimulation from family or others were not found for children with asthma specifically, but they were found in children with a disability [23].…”

Exploring the international uptake of the “F‐words in childhood disability”: A citation analysis

“…The additional nine sources described more broadly how the F‐words facilitate the participation of children with disabilities in PA and rehabilitation. Four sources (Adolfsson, ; Mäkelä, ; Pickering, ; Willis et al, ) encouraged professionals working with children with disabilities to use the F‐words as motivators/incentives to engage children in PA programs and rehabilitation‐based interventions. Similarly, Adolfsson () and four other sources (Järvikoski, Martin, Autti‐Rämö, & Härkäpää, ; Jeglinsky, ; Lauruschkus, ; Lauruschkus, Nordmark, & Hallström, ) highlighted the importance of incorporating “fun” into medical rehabilitation to promote children's participation and engagement.…”

Perceived facilitators and barriers for participation in leisure activities in children with disabilities: Perspectives of children, parents and professionals

“…Wright et al [27] call healthcare professionals the perhaps missing link to improve an active lifestyle and encourage behavioural change in individuals. Moreover, in recent years it has become more and more important to include the perspective of the children themselves [29][30][31][32][33][34][35]. This is especially stated in article 12 of the UN Convention of the Rights of the Child (UNCRC):…”