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Children with disabilities' perceptions of activity participation and

environments: A pilot study
Johanna Harding
Erline Wong-Sing

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Kimberly Harding I Patricia Jamieson
Mary Law I Theresa M. Petrenchik

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Maria Mullally

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Carolyn Politi

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Key words
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Participation

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Children

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Enfants

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Disability

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Photographs

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Case study

Mots clés
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Participation

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Handicap

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Photos

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Étude de cas

Abstract
Background. Children with disabilities are particularly vulnerable to participation restrictions resulting from the interactions
between children and their physical and social environments. Purpose. The purpose of this study was to gain a better
understanding of how children with disabilities view their participation in out-of-school-time (OST) activities in a range of
environmental settings. Methods. A case-study design was used to examine six children’s views on their OST activities using the
Children’s Assessment of Participation and Enjoyment (CAPE), photographs of their OST activity settings, and semi-structured
interviews. Findings. CAPE results indicated that the children participated most often in recreational activities. Through the use
of photographs and interviews, four major themes emerged that emphasized a deep interconnection between childhood
activities and settings. Implications. This unique pilot study contributes to developing an understanding for occupational
therapists about how children with disabilities view their participation, their activity environments, and how photographs can
be used to engage children in research.

Résumé
Description. Les interactions entre les enfants et leur environnement physique et social permettent d’observer que ceux et celles
qui sont atteints d’un handicap sont particulièrement vulnérables aux restrictions de participation. But. Cette étude avait pour
objectif de mieux comprendre la perception des enfants handicapés à l’égard de leur participation à des activités se déroulant à
divers endroits en dehors des heures de classe. Méthodologie. Une étude de cas a été utilisée afin d’examiner la perception de six
enfants différents au moyen de la Children’s Assessment of Participation and Enjoyment (CAPE), de photos prises lors des activités
en dehors des heures de classes et d’entrevues semi-structurées. Résultats. Les résultats de la mesure CAPE indiquent que les
enfants participaient le plus souvent à des activités de loisirs. Les photos et les entrevues ont permis de faire ressortir quatre
thèmes principaux mettant en valeur le lien profond qui existe entre les activités des enfants et les différents endroits où elles ont
lieu. Conséquences. En plus d’aider les ergothérapeutes à mieux comprendre comment les enfants handicapés conçoivent leur
participation et perçoivent les endroits où se déroulent leurs activités, cette étude pilote démontre comment la photographie
peut permettre de faire participer des enfants à la recherche.

n the International Classification of Functioning,
Disability and Health, the World Health Organization
(WHO) defines participation as involvement in a life
situation (2001). Participation in out-of-school-time (OST)
activities plays an important role in the promotion of
children’s health, well-being, and development. Participation
in such activities is positively associated with children’s
mental and physical health and the development of essential
skills, competencies, and social relationships (Forsyth &
Jarvis, 2002; Larson & Verma, 1999; Mahoney, Larson, &
Eccles, 2005; Simeonsson, Carlson, Huntington, McMillen, &
Brent, 2001). Involvement in the everyday activities of

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childhood has also been identified as an important predictor
of future life satisfaction (Kinney & Coyle, 1992).
Research pertaining to children with disabilities
identifies this population as particularly vulnerable to limited
participation, which results from the interaction between
children and their physical and social environments (Forsyth
& Jarvis, 2002; Law et al., 1999; Law, King, et al., 2006).
Recent studies have shown links between household income,
parent education level, or geographic region and the child’s
participation (Law, King, et al., 2006; Sloper, Turner,
Knussen, & Cunningham, 1990). Furthermore, King et al.
(2006) identified the child’s functional ability, child activity
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they found that child and family preferences were important predictors of children’s participation following adjustment for the child’s functional ability. is shaped by the environment.HARDING ET AL. Kortesluoma. The knowledge gained in this pilot study may inform the practice of occupational therapists and other health care professionals and will contribute to the future development of a larger research study. 2003). understanding children with disabilities’ unique perspectives is essential to the future development of programs. 1997). 1999. and one participant was from a singleparent family. or if participants or their parent(s)/guardian(s) felt uncomfortable or unable to respond to interview questions and questionnaires in English. In the present study. Canadian Association of Occupational Therapists [CAOT]. Prior to participation in the study. The purpose of this study was to gain a better understanding of how children with disabilities view their participation in OST activities and 134 JUIN 2009 I REVUE CANADIENNE D’ERGOTHÉRAPIE I NUMÉRO 3 I VOLUME settings. Researchers have acknowledged the importance of capturing children’s unique perspectives. photographs were used as a medium to give a voice to children with disabilities—a population whose perspective has often been overlooked in past research. Four participants had physical or motor impairments and two participants had developmental disabilities. which differ from adult concerns and perceptions (Coles. Two theoretical frameworks were used to guide the exploration of children with disabilities’ perspectives of their OST activities and their environments: The International Classification of Function and Disability ([ICF]. Colver. The CMOP is an occupational therapy model that depicts the dynamic interaction that exists between persons. 33). and gives meaning to occupations” (CAOT. 1995). & Lowe. p. The ICF recognizes that disability is a universal human experience and shifts the focus from the cause of a specific disability to the impact it has on the lives of people in society. Methods A case study design was used to gain a better understanding of the OST activities and activity settings of children and youth with disabilities. including one set of brothers. Tellis. 2005. which regards disability as a social issue and not an individual’s attribute (Forsyth. The sample consisted of five males. In this study. Included in the study were children and youth of either sex. Nonetheless. Spirituality lies at the centre of the model. WHO. as appropriate. services. Research on children’s issues has typically been conducted by gathering information about the child from sources such as parents and health care professionals without seeking the unique perspective of the child (Driessnack. Woolley. & Nikkonen. 1997). written consent was obtained from the parents or the guardians of participants and assent was obtained from the child participants. Hentinen. 2007). 1999). and opportunities to effectively meet their activity needs. Children were excluded if they were unable to communicate their activities and experiences (as judged by their parents at time of recruitment).). representing the idea that “spirituality resides in persons. Case studies are useful when exploring new or complex phenomena in order to obtain a more holistic view of the phenomenon of interest (Fitzgerald. Please note that typically developing children were not used as a comparison in this study. Study participants consisted of six English-speaking Caucasian children ages 8 to 13 with various physical and developmental disabilities. and attending the centre where recruitment was done. and one female. Five participants were from a two-parent family. Participants Ethical approval for the study was obtained from McMaster University and a children’s rehabilitation centre in southern Ontario. and family participation in social and recreational activities as major determinants of the child’s participation. living with a disability. Alvanides. cases consisted of a child or youth with a disability and a parent. Despite this recognition. environment. Stake. preferences. 1986). Participants were able to withdraw from the study at any time without consequence. The ICF takes into account the social model of disability. 2001) and the Canadian Model of Occupational Performance ([CMOP]. In addition. CanChild works in partnership with all Ontario children’s rehabilitation centres. and occupation (CAOT). 1999. and supportive relationships for the child indirectly influenced child participation (King et al. This centre previously completed research with CanChild Centre for Childhood Disability Research and had expressed an interest to be involved in any CanChild research that focused on children’s participation. that is. between the ages of 8 and 13. it examines multiple cases in order to develop a greater understanding of a phenomenon and explore new or under-researched areas (Fitzgerald. Children under the age of eight years were excluded from the study as children of this age have been found to be less able to reliably recall and articulate their activity participation and activity settings (Zwiers & Morrissette. They also found that factors such as family cohesion and parental perceptions of environments were relatively unsupportive. This pilot study is a collective case study. interviewing children poses unique challenges and many of the traditional adult interviewing techniques are not effective for eliciting children’s perspectives (Bradding & Horstman. Recruitment packages were sent to the children’s rehabilitation centre and then mailed by the administrator to eligible families. as cited in Driessnack). Five participants lived in a major urban 76 © CAOT PUBLICATIONS ACE . The photographs were used as a tool during the interview process to elicit information and descriptions of supports and barriers to children’s OST activity environments.

The student researchers conducted semi-structured interviews in the participants’ homes to discuss the content of photographs the child/youth had taken. Phase one of the CAPE is a self-administered questionnaire that measures the first two dimensions: which activities the child participated in and how often they had participated within the previous four-month period.. MacDougall.” and “Tell me what you like/don’t like about this place.32 to 0.and closed-ended questions was used to gain more information about the activity settings and participants’ perspectives of these environments. the CAPE allows the child to place importance on activities that are meaningful to them rather than on parental and other individual’s beliefs of what they consider is meaningful to the child. it has been noted that the use of multiple methods may produce richer data and a better representation of children’s experiences. and their associated meanings were captured using multiple methods. These questions allowed the participants to explore the positive as well as negative aspects surrounding their activity environments rather than placing a focus on their disability. 2003).HARDING ET AL. Specifically in relation to research with children. an interview guide with open. active physical. and having a parent/guardian present or involved as needed (Irwin & Johnson. & Dunn. Data collection Measures Participants’ views of their OST activities. “Tell me about this place and what you do here. 2004. How often a child participated is measured on a scale of 1 (“1 time in the past 4 months”) to 7 (“1 time a day or more”). minimizing leading. 2007). environment. Phase two of the CAPE measures the last three dimensions: where and with whom the child took part in activities and the child’s level of enjoyment. and © CAOT PUBLICATIONS ACE VOLUME 76 I construct validity has been established by comparison with known predictors of children’s participation and the Preferences for the Activities of Children (PAC. 1997). how often. and is one of the few existing instruments that directly measures participation (King et al. Law. using a disposable camera over a period of at least seven days. Test-retest reliability for the five scales on the CAPE range from poor to good (0. and semi-structured interviews. Based on the CMOP theoretical framework depicting the dynamic interaction that exists between person. 2005). 2005). using both openand closed-ended questions. including a standardized assessment. 2004). Questions asked in the interview guide included. The majority of the participants lived in a household with an annual family income of $60. King et al. these were consistent with the NUMBER 3 I CANADIAN JOURNAL OF OCCUPATIONAL THERAPY I JUNE 2009 135 .000).000 or more. Content validity was addressed in the tool development. Participant Sex Age Type of disability Mobility 1 M 8 2 M 13 3 M 11 4 M 13 5 M 10 6 F 13 Emotional/Behavioural/ Independent Developmental Emotional/Behavioural/ Independent Developmental Cardiopulmonary Independent/ Wheelchair Physical/Motor Independent impairment Wheelchair Physical/Motor Independent/ impairment Wheelchair Physical/Motor impairment Wheelchair community (population over 100. where. and their level of enjoyment. Level of activity enjoyment is measured on a scale of 1 (“not at all”) to 5 (“love it”). To address the uniqueness of interviewing children. TABLE 1 Participant information. The psychometric properties of the CAPE have been reported (King et al. 2006).. King et al. Examples of further questions beyond the interview guide included how the participant felt in a given environment and what was special about it. Thus. social.62) based on Cronbach’s alpha. and occupation (CAOT. The CAPE includes 50 activities within 5 activity types: recreational. the CAPE was the most appropriate measure as it is a self-report measure for children/youth ages 6 to 21 years.64 to 0. and self-improvement activities. their environments. with whom. Despite having some variability in its validity and reliability.000). These photographs were used as a tool to facilitate semi-structured interviews with the participants. Next.. Baum.86) based on intra-class correlation coefficients. The CAPE is a standardized assessment of children’s activity participation outside of school-mandated activities. Why?” They were developed from the researchers’ reflections on what basic questions would help encourage a child to describe an activity environment. It measures five dimensions of activity participation: the number of activities a child/youth does. photographs. special attention was given to building rapport with participants. and one participant lived in a rural community (population less than 3. especially if the methods help to engage the children’s attention and interest (Darbyshire. the Children’s Assessment of Participation and Enjoyment (CAPE. & Schiller. skill-based. 2005). Quantitative data and photographs were used selectively to enhance the qualitative interview data.. The use and integration of multiple sources of data help to support case findings and reduce the likelihood of misinterpretation (Yin. the CAPE was used in this pilot study as a measure that may be useful for a point of comparison in future studies. Participants were asked to select their two favourite places and one least favourite place. Children took photographs with parental/guardian help as needed. Internal consistency ranges from poor to adequate (0.

Confirmability was also supported by having a team of researchers along with expert input from experienced research supervisors. At that time.HARDING ET AL. Interviews lasted an average of 30 minutes and no longer than one hour. The families received postage-paid envelopes in which to return the cameras to the study team. and standard deviations) for CAPE data were calculated and served to 136 JUIN 2009 I REVUE CANADIENNE D’ERGOTHÉRAPIE I NUMÉRO 3 I VOLUME describe five dimensions of the participants’ activity participation. but all researchers viewed the photos during the coding process to be aware of OST activity environments that participants had photographed. The open-ended interview questions provided the child participants the opportunity to identify and explore the meaning of their activity environments. The total time commitment for each participant. the content of the photographs was discussed with the participants in semi-structured. Data for this pilot study was collected over the five-week time period available for the student research project. In the initial meeting at the participant’s home. Participants were then given a disposable camera and instructed to take photographs of their usual OST activity settings over a minimum of seven days. Dependability was reinforced by the description of an audit trail. Themes were subsequently developed by all researchers from an inductive analysis of the codes. and one pair of student researchers coded the remaining four transcripts once an understanding of the phenomenon had been established. Questions asked were also consistent with the ICF. as appropriate. Photographs were then developed and returned to participants during the second meeting. The six researchers analyzed the Interview transcripts using an inductive content-analysis approach (Graneheim & Lundman. and phase one of the CAPE to complete on their own. 76 © CAOT PUBLICATIONS ACE . Trustworthiness Several strategies were implemented during the research process to ensure the trustworthiness of the results (Letts et al. including both home visits. 2007). which places importance on the meaning behind the activity (CAOT. self-report demographic questionnaire. which recognizes that disability is a universal human experience and shifts the focus from the cause of a specific disability to the impact it has on the lives of people in society (Forsyth et al. Researchers did not have knowledge of participants or the recruitment agency prior to the study. Maintaining at least two researchers in this role guaranteed triangulation. triangulation in the use of quantitative and qualitative data. 1999). each team member read all six interview transcripts. The content of the photos was not analyzed per se. medians. The quantitative and qualitative data were used to develop a description of the nature and context of OST activities for the study participants. This involves grouping related codes and identifying them under a theme so that each code is captured in one of five themes.. and reviewed by the interviewers to check for accuracy. using a reflective approach on the part of the research team to increase awareness of personal bias. the researchers facilitated completion of phase two of the CAPE by the participant with the assistance of a parent. The entire student research team established a coding scheme based on the first two transcripts. transcribed. Before conducting interviews. An editing approach to analysis was also used in that codes emerged from the data and were not predetermined (Miller & Crabtree. Coding was done manually. families received a package in the mail containing a letter of information. Each pair of students interviewed at least one participant. The time constraints of the study precluded the use of member-checking to verify data and interpretation. 2007). each member of the study team used self-reflection to identify potential personal preconceptions relevant to the study and also identified and bracketed their assumptions about expected results. home-based interviews. 1997). Prior to the visit. A decision trail was documented by the researchers as a group throughout the analysis process.. Theoretical saturation cannot be presumed as sampling was not continued to the point of redundancy in the data because the time available for data collection was limited. To ensure that all researchers had an understanding of each participant’s perception of OST activities. was no more than two hours. clustering these codes into themes. and having multiple researchers. All interviews were conducted by pairs of entry-level master’s occupational therapy students. and there were six student researchers in total. Data analysis Descriptive statistics (means. participation intensity was also calculated by dividing the sum of item frequency by the number of possible activities in each activity-type scale. Procedure Families who expressed interest in participating in the study were contacted by a member of the study team to arrange an initial home visit. Using the CAPE data. and negative case analysis was used to ensure that all data were represented in the final themes. consent form. Transcription of the interviews was completed by an outside source and checked by the pairs who had completed the interviews. The same pair of researchers carried out both interviews (phase two of the CAPE and the semi-structured interview) with a given participant in order to establish and maintain rapport. Interviews were tape-recorded. The photographs that study participants took were used to illustrate and enrich interview findings. Credibility was ensured by using multiple methods of gathering data. This process involved coding statements based on their key concepts. and then refining the themes. 2004). CMOP.

negotiating the environment. The results of the mean intensity scores from the CAPE indicate that subjects participated the most in recreational activities (mean = 4. social activities (e. and selfimprovement activities (e. self-improvement (mean = 3. followed by social (mean = 4. Results Results from the CAPE were used to gain a general description of the participants’ participation over the fourmonth period from December to April prior to the interviews.85.. The mean intensity for formal and informal activities was also calculated.21. SD = 1.g. music lessons or horseback riding). FIGURE 1 Intensity of participation divided by activity type.77. Participants’ mean enjoyment indicated participants enjoyed physical activities most (mean = 4. © CAOT PUBLICATIONS ACE VOLUME 76 I NUMBER 3 I CANADIAN JOURNAL OF OCCUPATIONAL THERAPY I JUNE 2009 137 .53. SD = 0.67).. The five activity types include recreation activities (e.38. as well as the activities they do there.. physical activities (e.g. SD = 0. SD = 0.35).83.40). and skill-based (mean = 2. active physical (mean = 1. The CAPE was used to determine the intensity of activity (what form of activities children participated in the most) and the enjoyment of activities.g. SD = 1. Figure 4 demonstrates individual participant enjoyment scores for formal and informal activities.02) followed by social (mean = 3. SD = 0.87). connecting with the natural environment.73).g. swimming and track and field).19. from the Children’s Assessment of Participation and Enjoyment.05. whereas informal activities involve no planning prior to the activity. and supports and barriers.. SD = 0.. selfimprovement (mean = 2.20. SD = 0. SD = 0.42.49).72) than formal activities (mean = 1.g. Intensity scores for each subscale vary by participant as shown in Figure 1.85). standard deviation [SD] = 1. Participants demonstrated comparable mean enjoyment for both informal and formal activities. Specific enjoyment scores for each participant for subscales can be seen in Figure 3. Formal activities have designated leaders and rules or goals. Four themes emerged from these discussions: experience of place. skill-based activities (e. Table 2 presents the activity environments that participants identified when discussing the photographs of their favourite and least favourite activity settings. CAPE results group activities based on type as well as their formal or informal nature.15. recreational (mean = 4. playing with friends and talking on the phone).96) activities.HARDING ET AL.48).28).07. Participants in the study participated in more informal activities (mean = 3. SD = 0. Figure 2 illustrates the intensities for participants’ formal and informal activities. reading and going to the library). and skill-based activities (mean = 0. puzzles and watching television). SD = 0.

FIGURE 3 Enjoyment of participation divided by activity type.HARDING ET AL. from the Children’s Assement of Participation and Enjoyment. 138 JUIN 2009 I REVUE CANADIENNE D’ERGOTHÉRAPIE I NUMÉRO 3 I VOLUME 76 © CAOT PUBLICATIONS ACE . FIGURE 2 Intensity of participation divided by formality of activities from the Children’s Assessment of Participation and Enjoyment.

Participants often reported that there was nothing that they disliked about their favourite places. We come in. . Participants liked various aspects of the environment. NUMBER 3 I CANADIAN JOURNAL OF OCCUPATIONAL THERAPY I JUNE 2009 139 . When describing their least favourite place. including the people. Participants had positive feelings in many places. likes and dislikes. And then there’s a few songs of praise then you’ve got announcements and celebrations. the activity done there. relaxed. important. the activity. free. there’s the greeting. and thus difficult to differentiate from.HARDING ET AL. we . or annoyance. . but also noted many positive aspects. they felt happy. Participant 1 2 3 4 5 6 Favourite places Butterfly conservatory Park Road/Street Bedroom Bedroom Barnyard © CAOT PUBLICATIONS ACE Least favourite place Respite home Church Grocery store The path Church Park Living room Library Park Garden Library Movie theatre VOLUME 76 I experiences did not match their interests. Places were described as special and comfortable. . P4: It’s a comfortable place . They also reported that feeling accepted and having a choice of activity was important to them in their experience of place. and feelings about being in that place. . Participants’ health status also affected their experience. Our minister or one of our ministers celebrates every time that the Leaf ’s win a game. Experience of place Participants articulated both positive and negative experiences of place in relation to their level of enjoyment. fear. Experience of place was intertwined with. It’s fun some of the things that come up. excited. some of the negative feelings related to place and activity included feelings of anger. Participants enjoyed a variety of activities that they often found meaningful. and accepted. good. and nature. FIGURE 4 Intensity of participation divided by formality of activities from the Children’s Assessment of Participation and Enjoyment. participants identified aspects of the activity and environment that they disliked. Conversely. Positive experiences were often described as fun and matched their interests and abilities while negative TABLE 2 Participants photographs of activity environments. there’s special things we do every Sunday in service.

touch them . mostly a playground should be more . there was one plant. Connections with animals and nature were very apparent. for example.. P3: Ah. They reported using different assistive devices depending on the activity as well as occasionally having assistance from others to get around. Participants revealed an awareness of their individual needs. . puff ball spores. fuzzy plants. the participant explained: P5: Well . safety was ensured by various means depending on the nature of the environment and the activity. I liked some of the grass there. in the end I . looking 140 JUIN 2009 I REVUE CANADIENNE D’ERGOTHÉRAPIE I NUMÉRO 3 I VOLUME at and smelling gardens. . a lot of it’s because I really like playing with my stuffed animals in there and also I just like playing in there mostly.. Limitations of public places and accessibility contributed to negative experiences of place. Participants were able to identify ways of changing limitations within their environments. Participant Four’s description of a garden illustrates this theme: P4: I like the garden .. nuzzling a horse. . Two participants valued independence in activities while two other participants valued being alone in their bedrooms. there were a few plants there . that’s so nice. a plastic plant. riding bikes. Various means of transportation were used to access the activity environments. walking.. you actually get to . and watching wildlife and nature. . As participants and their parents were keenly aware of their needs. problem-solving skills. specifically related to their dislikes.. Figure 5 shows one participant’s photograph of a favourite activity setting. A photographic example relating to the experience of place theme. we began calling it tickle grass. an environment in which Participant One was able to come into physical contact with the creatures. Connecting with the natural environment The theme of connecting with the natural environment evolved from the way the participants described their interaction with their natural environment through their five senses. Uhm . Negotiating the environment Negotiating the environment is a theme that emerged from participants’ discussing moving around in... people he helped me back 76 © CAOT PUBLICATIONS ACE .HARDING ET AL. Driving by in my chair it would brush on me. there were some special things for people. like a playground should be more tarmac and it should be more accessible.. adaptability. Participant Two described negotiating the grocery store as follows: P2: I just go zoom and right out. especially for one participant who lived in a rural location. and positive attitudes while in different environments. There was one somebody started it looked like it was fake. and using wheelchairs. and one of the staff . tickle grass. stating: P1: Not a glass window. . When asked why this was a favourite place.. cell phone technology and community support were described.. Figure 6 portrays a butterfly garden.. For example. It looked that way but it was completely real. There were gardens for you to look at. It . smell. A picture of a butterfly garden corresponding to the theme of connecting with the natural environment.. I really liked. I like it. For example. a soft one. I think it was a drink. and ensuring safety in different environments.. .. participants also relied on adults for transportation. Participant Six discusses negotiating the environment as seen in Figure 7. The participant explained the experience of being in a butterfly garden. In that same garden there was a fuzzy plant. The type of transportation used also depended on time considerations and proximity of the place.. FIGURE 5 FIGURE 6 Experience of place (Participant 5). Connecting with the natural environment (Participant 1). taking public buses. touch . Participants were thus required to negotiate environments in order to successfully participate within them. Participants noted colourful butterflies. P6: Once I went at the theatre to get.. getting to.

These supports and barriers were part of both the physical and social environment. et al.. It was noted that participants did not necessarily have the highest intensity participation in the activities in which they also had the highest enjoyment. This study also noted different patterns of participation between genders. weather was not an issue. which may have upset them.HARDING ET AL. P3: I liked it but it’s just I don’t find it as accessible as the other places. Law. . and neighbours. though it has been noted that children with disabilities may be vulnerable to this (Forsyth & Jarvis. FIGURE 7 FIGURE 8 Negotiating the environment (Participant 6). but if I have like my manual one I . such as making guidelines in relation to their safety or not allowing them to watch certain movies. et al. Supports and barriers (Participant 3). especially if it made the use of wheelchairs difficult. Participant Three describes an environment where a barrier limits participation. A previous study using the CAPE with a large sample also showed higher participation in informal versus formal activities (Law. then I can’t really play with them. Finally. pets. There was no significant evidence of participation restriction. Supports and barriers Participants consistently identified aspects of their environments and activities that acted as supports or barriers to their participation. This photograph correlates to a barrier for one study participant and falls within the theme of supports and barriers. different aspects of the weather. Features that made an environment accessible as well as those that made a place physically comfortable were noted as supports. restricted their participation in certain environments. One participant described the navigation of this environment associated with the theme negotiating the environment. although results may indicate a bias in that parents who are actively involved with their children’s participation may have been eager to be a part of the study. King. . . The sample of the current study had only one girl and five boys. The CAPE data show that participants had the highest mean intensity of participation in recreational activities. 2002. 2006). such as snow and muddy terrain. Participants also said that their parents sometimes imposed different kinds of restrictions on them. as captured by the CAPE data and the qualitative interviews and as illustrated in their diverse photos. 1999. King. into the theatre. . Social supports came in the form of friends. it’s annoying when I get stuck because I don’t really mind using my wheelchair that much. nice helpers.. so I’m just sitting there and sometimes my friends come up . so there’s actually a little bench sitting area in the park and on the slide area where that house is. as illustrated by Participant Five’s comment: P5: Yeah. I can’t get it open on my own. their participation. Participants’ health issues were a barrier to their participation in some settings. . and participants spoke predominantly of supports rather than barriers.. if I have like my electric chair I can handle it. NUMBER 3 I CANADIAN JOURNAL OF OCCUPATIONAL THERAPY I JUNE 2009 141 . For some participants. which was really good because there’s [a] heavy door on the theatre which I can’t really push open by myself and then there’s the ramp to get up to like all the seating which some . so like my friends were here and I go. such as having different interests than others or not being able to control certain aspects of the social environment that affected their participation. Participants also enjoyed physical activities best as shown by the mean enjoyment data and had similar enjoyment of formal and informal activities. Only a few social barriers were noted. participants noted that not all environments were accessible and identified changes they would like to see made to make a place more conducive to © CAOT PUBLICATIONS ACE VOLUME 76 I Discussion The six children in this study participated in and enjoyed a wide variety of activities in various settings. and higher intensity of informal activities overall when compared to formal activities. whereas for others. . These findings could be a testament to participants and their families making participation in activities a priority. Law et al. and therefore no trends can be seen. 2006). In Figure 8.

. they did not name specific aspects of their own disabilities as barriers. 76 © CAOT PUBLICATIONS ACE . In contrast. this finding illustrates one of the theoretical frameworks used to guide the study. in discussing OST activities and activity settings. and these positive attitudes would presumably enhance their participation. they described actions they had already taken to advocate for change. children may say few words at a time or speak in a tangential way. but these young participants negotiated their environment and were able to have fun despite any setbacks. which incorporates the social model of disability and emphasizes the role of society. the findings may not fully describe the experiences of all children with physical or developmental disabilities (Morse. 2007. the activities. 2005). Using photographs in a qualitative interview also allowed researchers to engage children in research. Nonetheless. they shared ideas they had for changes that would minimize barriers in the future. Furthermore. Participants had positive attitudes when discussing their experiences. they proved to be an effective method in this study for several reasons. This may also indicate children’s developing ability to advocate for themselves. compared with only one least favourite place. These connections provided opportunities for discovery and learning. previous authors (Heah. King et al. Furthermore. For example. It is significant that all participants described positive experiences with nature or animals. Having the participants then elaborate on their photos allowed the researchers to understand their experiences in greater depth. this may simply reflect their perception of their parents’ role. for personal reasons or simply because their families do not go there. For example. In essence.” This was seen with the park and church activity environments. Ziviani. 1999). interviewing children has been described as challenging for various reasons (Irwin & Johnson. participants’ experiences highlighted that the setting and the activity were closely interconnected. the CMOP (CAOT. Participating in some environments or activities may not always have been straightforward. By asking about children’s life experiences and using photographs as a tool to see through their eyes.. Children viewed people in the environment as helpful and rarely described the social environment as a barrier to participation. This observation is also consistent with the ICF (WHO.. the findings are weighted towards favourite places since two of these photographs were discussed. Case. In general. 1997). this study provided children with an opportunity to share their ideas for change. Finally. McGuire. disability came across as a part of their lived experience and they named factors in the environment around them as barriers. This may have been because they were asked to take pictures of places they go to. the social support necessary for participation stood out.HARDING ET AL. as it speaks to the dynamic interaction between the participants. 2005. For example.. For some participants. participants focussed on the positive and were more easily able to articulate what they liked about both favourite and least favourite places as opposed to what they disliked. and therefore researchers need to be cautious not to miss the value of a small or seemingly unrelated comment (Irwin & Johnson) in the interview and when analyzing the data. 142 JUIN 2009 I REVUE CANADIENNE D’ERGOTHÉRAPIE I NUMÉRO 3 I VOLUME This is in contrast with a previous finding that social barriers. when asked about their likes and dislikes. The time constraints of the study also precluded the use of member-checking. In this way. children did identify some barriers to participation. & Law. a discussion of people’s views of an environment naturally leads to ideas of how to change and improve it. for example. 2006). including pets. Both participants and their parents were receptive to taking photographs. and activity settings. the current pilot study expands on previous studies in which children took photographs but did not have the opportunity to discuss them (Darbyshire et al. and this may have had an impact on both the data collected and the analysis. though steps were taken to interview the participants in a child-friendly way. The findings of this pilot study are limited for several reasons. & King. including attitudes. including its environments. Participants’ ability to connect to an environment was an important aspect of their experience. Also. children may be more easily led by words an interviewer uses (Irwin & Johnson). In some cases. 1997). in fact. Thus. participants often cited that they liked a setting because of the activity they did there. which is a useful way of increasing trustworthiness. This also relates to previous findings that participation was better predicted by combined positive factors related to the subjects and the environment rather than by type of disability or diagnosis (Almqvist & Granlund. Participants’ many activities clearly brought meaning to their lives. Since the themes did not reach saturation.. Petrenchik. In other cases. in creating disability. Law. some children actually took up photography as a new hobby after using the cameras. Overall. 2005). however. This finding is similar to that found in the literature that describes participation as an experience of engaging in meaningful occupations and maintains that participation is important to health (CAOT. 2001). were in fact a significant environmental barrier (Law et al. Law et al. and it was a communication tool to elicit their experiences and ideas. they allowed researchers to access participants’ unique views in that a given place might be named by one participant as “favourite” and by another as “least favourite. Also. as seen in a previous study (Law et al. and they may rarely frequent places that they dislike. accessibility was raised as a common challenge. Interestingly. 2004). 2006) have noted. 1999). an observation that. Though the participants’ photographs were not analyzed in a systematic way. and this may have influenced the content of the transcripts. the use of cameras was an important factor in their decision to participate in the study. the young participants did not explicitly name their parents as supports.

& Granlund. This pilot study demonstrates that many opportunities remain for developing further research that explores the relationship between children’s participation in OST activities and the activity settings. Woolley. P. therefore. Quality in Health Care. Ultimately. S. L. the children did not focus on how their disabilities limited their participation. they were able to fulfill a major goal of activity participation for all children: having fun. 345-349. Darbyshire.. References Almqvist. The results of this study should encourage other researchers to employ the voices of children in future research endeavours. Health and Development.. & Lundman. (1997). (1999).. 415-423. ON: CAOT Publications. more homogenous sample in order draw stronger conclusions related to the perspective of one group. M. M. Hamilton. Also. social programming. It was also noted that participants volunteered ideas to change and improve the activity environments around them. Boston: Atlantic. Special thanks to the children and families who participated in this project and shared their unique voices with us. Participants often enjoyed activities when they felt connected to the environment and if the activity setting provided physical or social supports to enable their participation.. Participation in school environment of children and youth with disabilities: A personoriented approach. Case studies as a research tool. The political life of children. the results may encourage health care practitioners such as occupational therapists to focus on what a child can do and a child’s participation rather than on participation restriction. Coles. This research project provided them a platform from which they could share their ideas for change. 46.. • Participants’ experiences highlighted that the setting and the activity were closely interconnected. Acknowledgements The authors would like to thank the child development centre and their staff as well as the CanChild Centre for Childhood Disability Research. R. The application of this client-centred research is important not only in the exchange of critical information between © CAOT PUBLICATIONS ACE VOLUME 76 I researchers and health care service providers. The voices of children can be valuable to future research.. future research could focus on a larger. Forsyth. Colver. (2002). U. especially to maintain a client-centred focus. B. This is certainly a reminder of the importance of involving people with disabilities when developing policies that will influence them as they are the end-users and have an expertise based on their life experiences. S. Fitzgerald. (2007). Other areas for further investigation include advocacy by children with disabilities and the roles that families and communities play in facilitating or limiting a child’s participation. Multiple methods in qualitative research with children: More insight or just more? Qualitative Research. this study provided a platform that gave these children an opportunity to share their ideas and to speak about their activities and environments using their own voices. along with their social supports. Enabling occupation: An occupational therapy perspective. Ontario. M. Participation of young severely disabled children is influenced by their intrinsic impairments and environment. L. but it is also beneficial in ensuring that this unique client-centred perspective is included in government policy and ultimately reflected in all facets of health care. For example. 5.. 75-76.. and service provision for all children. (2005). are able to negotiate the environment to participate and have fun. Canadian Association of Occupational Therapists. 305314. Children’s drawings as facilitators of communication: A meta-analysis. (2004). Journal of Pediatric Nursing. 417-436. a group of children with disabilities could be compared with a group of typically developing children to look at similarities and differences in participation in OST activities and views on activity settings. This study included children with varied disabilities. 20. Occupational therapists may be in roles in which they can partner with children and families to facilitate this process. W. Scandinavian Journal of Psychology.HARDING ET AL. Key messages • This pilot study explored OST activity participation from children’s perspectives. Alvanides. A. Despite experiencing environmental barriers. MacDougall. Child: Care. For example.. Conclusion This study demonstrates the wide variety of activities and the respective settings experienced by six children with various disabilities. R. Qualitative content analysis in nursing research: Concepts. & Schiller. & Lowe. (2005). M. Participation in childhood. C. this study shows that children with disabilities. • Participants described actions they had taken to elicit change in order to enhance their participation. procedures and NUMBER 3 I CANADIAN JOURNAL OF OCCUPATIONAL THERAPY I JUNE 2009 143 . Toronto. 277-279. H. (2005). (1986). Using photographs in a qualitative interview was an effective method to engage children in research and elicit their experiences. R. for their support with this research. 28. By interviewing the young participants. Future studies could use larger samples to allow for a better comparison with previous CAPE studies with large samples or to make it possible to have two groups within a study to allow for comparison. Driessnack. 49. This study has relevance to clinical practice with children with disabilities and to policies that influence the built environment. Graneheim. Developmental Medicine and Child Neurology. & Jarvis. Forsyth. 8. but rather they adapted to and overcame these obstacles.

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