2.2.1 Participation rates in physical activity
The WHO (2004) estimate that, worldwide, 60% of adults do not engage in levels of physical activity that will benefit their health and that physical inactivity is greater among people with disabilities, women, older adults and those from lower socio-economic groups. There is limited, though growing, descriptive and comparative data on physical activity patterns and participation rates of people with disabilities. Where data exists, people with a disability generally engage in less physical activity than their non-disabled counterparts. This does vary, however, depending on circumstances, incentives, barriers and personal factors. (Where barriers have been significantly dismantled and participation and quality of experience facilitated, participation rates increase).
Sport England, the national sports development agency for England, sent a questionnaire in 1999 to 5,600 disabled children and young people in England and Scotland aged 6 to 16 years (Finch et al, 1999). There was a 50% response rate. The questionnaire was modelled on that used for the young people and sport national 1999 survey so that comparisons could be made. In nearly all contexts, and for all sports, children with a disability did not participate in sport and leisure activities as much as non-disabled children
In another English study the proportion of a sample of young people with intellectual disabilities taking part in sport was considerably lower that in a matched sample of young people in the general population (Flynn et al, 1992). Among those with a learning disability, those with profound and multiple disabilities tend to have the lowest levels of physical activity (Lancioni et al, 2003 cited by Boland) but level of physical activity can also be very low in those with mild or moderate disability (Messent et al, 1999a).
Steele et al (1996) found that 39% of a group of 101 Canadian adolescents with physical disabilities reported that they never exercised compared to 6% of a large national sample. The only activity in which children with physical disabilities outscored their non-disabled peers was in watching TV more than 4 hours per day (39% compared to 13%).
Aitchison (2003) studied leisure patterns of 11 -15 year old people with disabilities in South West England through leisure diaries and focus groups. The main finding was that these children shared many of the same leisure priorities (primarily sedentary) as other children. Information Communication Technology (ICT) was the number one leisure activity for all children. There were differences in both the amount of leisure activity and in the social circumstances of their activity between children with and without disabilities. With the exception of ICT, children with a disability spent less time on all other leisure activities. They did more on their own or with their parents than with friends. In spite of their reduced leisure activity and opportunities for socialising in comparison to their peers, these children and their parents put a very high value on leisure as an opportunity for social interaction.
Modell et al (1997) surveyed the parents of children with developmental disabilities and found that 55% of the sports activities occurred with their families. The top three activities listed (swimming, walking/jogging and bicycling) are individual rather than team-oriented sports.
Rimmer (1999) found that less than 10% of African-American women with physical disabilities participated in any kind of structured physical activity programmes and cites other studies such as Coyle and Santiago (1995), Painter and Blackburn (1988) and Santiago, Coyle and Kinney (1993) that show that physical activity is a missing component in the lives of many people with disabilities. Other research in the US shows that some of the most common leisure activities for people with disabilities are watching television and listening to the radio (Modell et al, 1997) and that many adults with disabilities are socially isolated from their communities (Kaye, 1997). In a study by Sands et al (1994) 80% of people with disabilities had not gone to an athletic club in the past year. In the same study 71% of people with disabilities had not attended any sporting event in the year compared to 43% of people without disabilities.
The U.S. Forest Service conducted a National Survey on Outdoor Recreation and the Environment (NSRE) of the U.S. population (Jan. 1994 to April 1995) that included 17,216 Americans over the age of 15 and 1,252 persons in this sample reported a disability (7.7% of the total NSRE sample). Interestingly, this group of people with disabilities participated in outdoor recreation at rates equal to, or somewhat lower than, people without disabilities. However, in the youngest and oldest age groups, people with disabilities participated at rates equal to, or greater than, people without disabilities. Patterns of participation in outdoor recreation were similar across most activities for people with and without disabilities. Activities with the highest rates of participation among people without disabilities also tended to show the highest rates of participation among people with disabilities (www.ncaonline.org). This may illustrate that, as barriers are eliminated, participation in physical activities by people with disabilities increases. In the United States of America, in the Scandinavian Countries and also in the UK, much more work has been done in removing environmental barriers and facilitating access to the countryside than has been done in Ireland.
A MRBI Omnibus Survey carried out on the adult Irish population in November 2004 for the NDA, showed that non-disabled respondents were more likely to engage in regular exercise than respondents with disabilities and that taking no exercise was twice as frequent among people with disabilities (survey results, www.nda.ie).
Boland, 2005 (unpublished) carried out a study to assess health behaviours and health promotion needs of people with disabilities attending residential, respite, day service or training facilities in the former East Coast Health Board Area. This study found that one sixth of those with learning disability and a third of those with physical or sensory disability had done no physical activity at all in the last week (425 people participated in this study with physical, sensory and intellectual disabilities). Only 2% of persons with physical/sensory disability participated in sports weekly.
In this study physical activity was classified as strenuous (sweating, out of breath, heart beating faster), moderate (a little out of breath but heart not beating faster) or mild (minimal effort such as gentle walking). Of those with physical/sensory disability 44% did mild physical activity weekly (mainly mobilisation and gentle stretching exercises), 18% carried out moderate physical activity and only 4% did weekly strenuous activity. Of those with learning disability 29% did mild physical activity, 40% carried out moderate physical activity while 15% did weekly strenuous activity. 18% of those with a learning disability and 11% of those with a physical or sensory disability met with WHO physical activity recommendations. In Boland's study in the East Coast Area people with disabilities who were living in residential settings were more likely to reach recommended activity levels. Boland argues that this may be because staff in these residential settings motivate clients to exercise.
The Local Sports Partnership (LSPs) in Sligo and Donegal together with the North Western Health Board (Action Plan, Dec 2004) explored participation rates in physical activity and barriers to participation through two sports fora and consultation discussions with six groups composed of people from the disability services (learning disability, physical and sensory disability and mental health). All 119 participants in this study were connected to either a NWHB service or a support/advocacy group within their locality. Most of the participants were not members of any specific sports club but more than half were currently partaking in a sporting or physical activity 2-3 times a week through the disability services. Only a small number of participants (8%) undertook and organised activities by themselves. However, more than 50% were partaking in a sporting or physical activity 2-3 times a week through disability services.
People with disabilities in Ireland participate as part of the general population, in National Studies such as SLAN (1998, 2002) and HBSC (1998, 2002). Both of these studies contain a question on disability/chronic illness and a question on physical activity. This facilitates a profile of the physical activity patterns of people with disabilities and/or a chronic illness being extracted from the data (to be published shortly in an NDA Disability Agenda). In most national surveys people resident in institutions including prisons and residential care are not included.
A draft CSO report (2005), which analyses the Statistical Potential of Administrative Records and Survey Data Sources in selected Government Departments, outlines current sources of data on physical activity and sport and this report highlights a number of opportunities for gathering data on physical activity among people with disabilities. It is important that people with disabilities would be identified in these periodic surveys so that participation rates and progress in achieving targets set can be monitored. A National Disability Survey will be carried out in 2006 after the census.
2.2.2 Factors influencing participation
In order to suggest strategies or approaches that will increase participation rates, the environmental, social, psychological and personal factors that increase and decrease (barriers) participation by people with disabilities in sport and physical activity must be identified. It is also important to understand the process of behaviour-change in people with disabilities e.g. how they move from inactivity to activity and vice versa. Barriers and incentives to participation in sport and physical activity exist for all people but people with disabilities often endure additional barriers. In this section the literature review focuses on factors influencing participation of people with disabilities in physical activity.
The Local Sports Partnership in Sligo and Donegal together with the North Western Health Board (NWHB) explored participation rates in physical activity and barriers to participation (Action Plan, Dec 2004). Two sports fora were held and consultation discussions with six groups composed of people from the different disability services (learning disability, physical and sensory disability and mental health). All 119 participants were connected to either a NWHB service or a support/advocacy group within their locality. The two main barriers to participation identified by participants were a lack of transport and a lack of local facilities (more than 50%).
The Kerry Network of People with disabilities carried out a needs assessment of 104 people with disabilities in County Kerry (2000). Prohibitive factors in this study, discernible across all disabilities and across all social venues and activities (including the pub, disco, gym, cinema, theatre, sports-field, swimming pool or church), included the following: transportation, the absence of a companion or 'company' and negative attitudes towards people with a disability especially in the context of participation in sports.
The NDA commissioned a Market Research Bureau of Ireland (MRBI) survey representative of the adult population in the Republic of Ireland in Nov 2004 to examine the social participation of people with disabilities. The survey covered 500 people with a disability and 809 people without a disability. People with disabilities were significantly more restricted in their social life and in getting out and about than non-disabled people. Taking no exercise was twice as frequent among people with a disability. The results point to accessibility problems rather than health issues as important factors in restricting social participation. Twice as many disabled people as non-disabled people did not drive a car regularly. About 30% of disabled people who could not use public transport said it was because they could not get from their home to the bus stop or access point. Another 30% said it was because they could not physically get on to the bus or train. Looking at these two situations combined, a quarter of disabled respondents reported having neither access to public transport nor to regularly driving a car. This is compared to 5% of the non-disabled (Survey results, NDA website, www.nda.ie).
The consultation paper, Building Pathways, written by the Technical Advisory Group (TAG) of the National Coaching and Training Centre (NCTC) in 2002, discusses gaps in the Irish sports system. The paper considers that there is, too often, insufficient acknowledgement of the barriers that exist to participation and achievement.
Citing Duffy et al (2003), TAG highlights the fact that Article 42.3.2 of the Irish Constitution does not contain the word physical. This means that the inclusion of PE at primary and secondary levels is not guaranteed. Physical literacy is inadequate largely because a strong, well-implemented physical education (PE) curriculum in primary schools in Ireland is missing (Deenihan, 1991; Dept of Education, 1990; McGuiness et al, 1996; Duffy, 1997 as cited by TAG, NCTC, 2002).
Good physical literacy foundations must be laid down at the appropriate moment of the life course. Within the current primary school PE curriculum exposure to basic motor skills is not adequate to promote the required levels of physical literacy to underpin participation, performance, excellence and health objectives. There is an absence of guidelines for parents on the nature, level and number of sports activities that should be undertaken by their children, with or without disabilities, to maximise their physical literacy and sporting potential (TAG, 2002).
The NCTC TAG report considers that in Ireland there can be too much emphasis on competition to the detriment of practice at key phases of the development of children in sport. There can be an inappropriate focus on winning rather than on development. There is, sometimes, an increased pressure on children to specialise too soon resulting in early drop out. (Presumably this emphasis can be on the part of parents, sports bodies, coaches, teachers and, also, as a result of structures that reward primarily competition rather than participation.) A rational system of competition is absent and this inhibits optimal training and performance. Adult competition schedules tend to be superimposed on young players so that they do not spend sufficient time learning and mastering basic sport specific skills (TAG, 2002).
The TAG paper considers that National Governing Bodies of Sport are not proactive enough in providing opportunities for individuals with disabilities to participate in physical activity. Mainstream coaches are often reluctant to engage with players and athletes with disabilities. This can be due to a lack of knowledge on the nature and type of disabilities. There is also a lack of awareness that a coordinated individualised coaching plan can be developed for the person with a disability and administered with competence by the mainstream coach. There is a need for a much stronger focus and investment on the early phases of development, including physical literacy, within coaching and coach education. Coach education programmes are not designed with close enough reference to the phase of development at which the coaches will be operating and adult training programmes are often superimposed on children and male training programmes on women (TAG, 2002).
Due to the shortcomings of player/athlete development during the early phases, many will never reach their optimal performance levels while recruitment and talent development are largely neglected. TAG (2002) recommends the progressive development of integrated pathways in each sport with national coordination and local implementation. There is a need to map out sport-specific pathways based on a sound model of Long-Term Player/Athlete Development. Unless changes are made to the sport system to encourage participation in training at an early age, the recently established support systems e.g. the International Carding Scheme and Athens enhancement programme will not be able to fulfil their potential (TAG, 2002).
Sport England, the national sports development agency for England, surveyed 2,800 disabled children and young people in England. They found that, in this young population, lack of motivation or desire to take part in sport did not explain the low participation of sport by young disabled people. In this study, the most common barriers to participation in physical activity were having no one to go with, unsuitability of local sports facilities, a lack of money, and health considerations. Young people with a self-care related disability and those with a mobility disability were more likely to cite their disability, or gaps in sports provision as reasons for not participating in sport. Young people with a hearing disability were more likely to cite reasons that were less connected to their disability (Finch et al, 1999).
The UK organisation, Contact a Family, carried out a survey in the UK of families' experiences of play and leisure and 1,085 UK parents completed the survey (Shelley, 2002). Just under half were of primary school age and most children had more than one disability with 72% of the children having a learning disability and 62% having communication difficulties. This survey showed that families faced many barriers to participation and were put off even attempting to use many leisure facilities. Public attitudes and practicalities such as long queues and inaccessible transport put parents and children off. In this survey 79% of the children had never been to a football match and 72% had never visited a museum. When families did try to use leisure facilities they often encountered rigid rules and obstacles mainly due to the attitudes of providers and staff at all levels. This was true for children with all kinds of disabilities, physical, learning and sensory.
Mitchell and Sloper (2001) from the Social Policy Research Unit, University of York, reviewed play and leisure services for children with disabilities and their families. They found evidence that older children in particular reported difficulties accessing social and leisure facilities (Watson et al, 1999; Beresford, 2002); that the lack of inclusive activities leads to boredom and loneliness and means that children with disabilities spend more time at home and more time watching television than non-disabled children (Mulderij, 1996).
Unsuitable housing excludes children from everyday play and leisure activities within the home and parents suggest that if mainstream services were more accessible and they had better housing they would have less need for short-term care (Mitchell et al, 2001 citing Oldman et al, 1998).
Significant differences in habitual physical activity occur depending on the type of disability and activity levels varied with age (Longmuir & Bar-Or, 2000) and are related to both the type of disability and to the barriers to participation that exists with regards different disabilities and to other factors that may compound discrimination and prejudice. Unfriendly and negative attitudes (the absence of inclusive approaches) can create insurmountable barriers to participation for many people with disabilities around the world (Rimmer, 2003 citing Stark, 2001 and Stuifbergen et al, 1990).
In the United States it is estimated that there are 36 million mobility challenged travellers that do not shy away from travel and that are loyal to destinations that are sensitive to their needs (Ray and Ryder, 2003). Evaluation of accessibility shows that there are substantial barriers that impede wheelchair users from undertaking physical activity. In Kansas, for example, it was found that most facilities still had at least one barrier that would impede those with physical disability from using the facilities (Nary et al, 2000 cited by Boland, 2005).
For persons with a learning disability barriers to undertaking physical activity include (a) unclear policy guidelines in residential and day centre facilities, together with (b) resourcing, staffing and transport constraints; (c) participant income and expenditure and (d) limited options for physically active community leisure (Messent et al, 1999b cited by Boland, 2005). Messent et al (2000) also flags the fact that choice by many people with disabilities is not facilitated and so they sometimes cannot chose an active lifestyle.
In a qualitative study on leisure involving 29 older people with a learning disability, lack of self-determination in leisure was a key issue with few opportunities for participants to choose leisure activities (Rogers et al, 1998).
The services viewed most positively by disabled children are those which promote friendships, and offer opportunities to go out into the community, join in with leisure activities, and develop skills in an entertaining setting (Mitchell et al, 2001) Mitchell and Sloper (2001) highlight how participation in inclusive play and leisure services requires a multi-agency approach, involving leisure, education, social services, transport and housing. Inclusion is something that has to be actively supported (Beresford, 2002). A number of factors appear to be important in promoting inclusion (Petrie, et al, 2000 and Thompson et al 2000) including staff knowledge and training, adequate resources and staffing to assist children during activities, suitable environments, such as soft play facilities, which are barrier free and minimise the effects of differences in children's abilities.
Innovative services in Ireland include those where the participation of people with disabilities in community activities is facilitated. One example of such a service is that provided by Breannán Services (Hospitaller Order of St John of God) in County Kerry and a similar service has now been implemented by COPE Foundation in Cork which provides a range of services for people with intellectual disabilities.
The Breannán Services provide day and support programmes and community services. A social and recreational service is part of the community service. This service aims to support the inclusion of people with intellectual disabilities to pursue their interests and hobbies in their individual communities. The service includes a needs assessment, a skills assessment, leisure sampling with the client (who accompanies client as a friend and not as a service provider), independence within the activity with gradual withdrawal of support and monitoring. The type of physical activities engaged in by the 156 adults availing of the service (May 2005) include walking clubs, soccer, swimming, basketball, golf, bowling, aerobics, gym, football and adapted physical activity programme (Personal Communication, Cait O' Leary and presentation at 2nd National APA Conference in Ireland, May 2005). This service illustrates that when access to a wide range of activities is facilitated there is uptake by people with disabilities. Much work needs to be done on illustrating such cases of best practice demonstrating what can be achieved in order to open up access to people with disabilities. Some other examples of best practice are given in Appendix 5.
More studies have been done on the non-disabled population than on the disabled population. It is likely that the factors that influence participation in sport and physical activity generally will also be shown to influence the participation of people with disabilities. Appendix 4 contains a brief review of some of the factors found to influence participation in physical activity through research carried out in the general population. These factors include, for young people, parents' interest in physical activity, parental exercise habits, parental encouragement, social relationships, satisfactory physical activity experiences in school, the local environment, participation in organised sports and playing sport for school. In a study on ethnic minority students in Scotland (Sportscotland, 2001), the factors that influenced participation included:
- the attitudes and expectations of significant others, particularly parents and teachers;
- cultural traditions including a lack of acceptance of the value of sport, particularly compared to other aspects of life such as earning a living and family commitments;
- a lack of awareness of others `like me´ participating in sport and
- a lack of role models at a higher level;
- lack of confidence in relation to appearance, communication and ability;
- lack of awareness of appropriate sporting environments;
- lack of appropriate facilities or activities;
- difficulty in accessing information;
- cost and racial discrimination including overt racial abuse,
- covert racial abuse or lack of understanding of or sympathy with needs.
Other factors included
- (a lack of awareness of the benefits of physical activity,
- lack of political support for physical activity,
- insufficient cooperation between sectors and
- inaccessibility of leisure and sports facilities.
In summary, there are a number of important barriers to participation in physical activity in Ireland. The importance of physical activity experiences during the key years of a child's life in terms of developing physical literacy and pursuing lifelong participation in physical activity draws attention to the centrality of ensuring adequate PE in schools as well as adequate inclusive community physical activity programmes. Much depends on this. Other barriers to physical activity participation in Ireland include:
- Insufficient information;
- Lack of access to appropriate expertise including a lack of know-how on the part of service providers (such as coaches, leisure centre staff) and friends and family;
- No transport, inaccessible transport or lack of suitable transport to particular venues;
- Lack of companions/volunteers;
- Negative attitudes;
- Lack of time and costs.
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