Health and Social Development, Faculty of (Okanagan)
Health and Exercise Sciences, School of (Okanagan)
DSpace
UBCO
Jevdjevic, Aleksandra
Master of Science - MSc
University of British Columbia
Introduction: This study aims to explore the physical activity (PA) levels and quality participation experiences of children with physical and/or sensory disabilities during physical education (P.E.) classes. Little is known about how these children interact with their school environment and engage in moderate-to-vigorous physical activity (MVPA) in various settings. Understanding the participation levels and experiences can help develop inclusive PA programs for children with disabilities. Objectives: 1) To measure the daily amount of PA among children with physical and/or sensory disabilities; 2) To measure the amount of where and in what type of settings they have organized P.E. activities; 3) To describe their participation experiences during P.E. classes. Methods: The research uses a mixed-method approach, combining accelerometry and semi-structured interviews with both the children and parents/guardians. Accelerometers were used to capture moderate-to-vigorous physical activity levels (MVPA) overall, at school and during P.E. during a 7-day period. The follow-up interviews inquired about the content of P.E. activities and the experiences of participation or non-participation. Results: The study included 11 participants, with 45% having sensory disabilities and 55% having physical disabilities. On average, children engaged in 34.48 minutes of MVPA per day. During school time, they participated in 21.28 minutes of MVPA, while a typical 48-minute P.E. class had an average of 5.45 minutes of MVPA. The interviews identified both negative and positive elements of quality participation during P.E. classes. Conclusion: The study findings highlight the diverse experiences and perspectives of children with disabilities in their P.E. participation. These insights may guide educational institutions and policymakers in prioritizing and supporting P.E. for children with disabilities and fostering an inclusive and supportive environment that enhances their overall development and quality participation.
THE EXTENT, CONTEXT, AND EXPERIENCES OF PARTICIPATING IN PHYSICAL EDUCATION ACTIVITES AMONG CHILDREN WITH PHYSICAL AND/OR SENSORY DISABILITIES by Aleksandra Jevdjevic B.H.K, The University of Banja Luka, 2017 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE in THE COLLEGE OF GRADUATE STUDIES (Health and Exercise Sciences) THE UNIVERSITY OF BRITISH COLUMBIA (Okanagan) August 2023 © Aleksandra Jevdjevic, 2023 ii The following individuals certify that they have read, and recommend to the College of Graduate Studies for acceptance, a thesis/dissertation entitled: The extent, context, and experience in participating in P.E. activities among children with physical and/or sensory disabilities submitted by Aleksandra Jevdjevic in partial fulfillment of the requirements of the degree of Master of Science . Dr. Kathleen Martin Ginis, School of Health and Exercise Sciences Supervisor Dr. Christine Voss, Southern Medical Program Co-supervisor Dr. Heather Gainforth, School of Health and Exercise Sciences Supervisory Committee Member Dr. Kelly Arbour-Nicitopoulos, University of Toronto Supervisory Committee Member Dr. Lesley Lutes, Irving K. Barber Faculty of Arts and Social Sciences University Examiner iii Abstract Introduction: This study aims to explore the physical activity (PA) levels and quality participation experiences of children with physical and/or sensory disabilities during physical education (P.E.) classes. Little is known about how these children interact with their school environment and engage in moderate-to-vigorous physical activity (MVPA) in various settings. Understanding the participation levels and experiences can help develop inclusive PA programs for children with disabilities. Objectives: 1) To measure the daily amount of PA among children with physical and/or sensory disabilities; 2) To measure the amount of where and in what type of settings they have organized P.E. activities; 3) To describe their participation experiences during P.E. classes. Methods: The research uses a mixed-method approach, combining accelerometry and semi-structured interviews with both the children and parents/guardians. Accelerometers were used to capture moderate-to-vigorous physical activity levels (MVPA) overall, at school and during P.E. during a 7-day period. The follow-up interviews inquired about the content of P.E. activities and the experiences of participation or non-participation. Results: The study included 11 participants, with 45% having sensory disabilities and 55% having physical disabilities. On average, children engaged in 34.48 minutes of MVPA per day. During school time, they participated in 21.28 minutes of MVPA, while a typical 48-minute P.E. class had an average of 5.45 minutes of MVPA. The interviews identified both negative and positive elements of quality participation during P.E. classes. Conclusion: The study findings highlight the diverse experiences and perspectives of children with disabilities in their P.E. participation. These insights may guide educational institutions and policymakers in prioritizing and supporting P.E. for children with disabilities and fostering an iv inclusive and supportive environment that enhances their overall development and quality participation. v Lay Summary This study helps us understand how children with physical and/or sensory disabilities experience P.E. classes. This study tells us children are not as active as recommended. By knowing their experiences and what affects their involvement, we can make P.E. classes better for all children. We need to consider both the good and not-so-good aspects of their experiences to create a helpful and encouraging environment in P.E. classes. This understanding can guide us in developing ways to make P.E. classes better for children with disabilities. Doing so will allow them to be more involved and experience participation. . vi Preface I, Aleksandra Jevdjevic, confirm that this dissertation is my original work. It is a part of the larger project called "Feasibility of qualitative-geospatial methods to investigate physical activity behaviors in children with disabilities in British Columbia." In this thesis, I conducted the literature review, recruited participants, collected data, performed data analysis, and wrote the thesis. Dr. Kathleen Martin Ginis and Dr. Christine Voss supervised the entire study and provided guidance throughout the research process, including editing of the thesis. The study protocol was approved by The University of British Columbia Okanagan Behaviour Research Ethics Board under the code H22-00842. This research has not been published yet. vii Table of Contents Abstract ...................................................................................................................................... iii Lay Summary .............................................................................................................................. v Preface ........................................................................................................................................ vi List of Tables ............................................................................................................................... x List of Figures ............................................................................................................................ xi List of Abbreviations ................................................................................................................ xii Acknowledgements ................................................................................................................. xiv Dedication ................................................................................................................................. xvi Chapter 1: Introduction ............................................................................................................. 1 1.1 Disability defined ......................................................................................................... 1 1.2 Epidemiology ............................................................................................................... 1 1.2.1 Children with disabilities in Canada ....................................................................... 1 1.3 Physical activity levels of children with disabilities in Canada ..................................... 3 1.4 Factors influencing participation in physical activity by children with disabilities ......... 4 1.5 School-based Physical Activity and Physical Education ............................................. 6 1.6 Quality Participation .................................................................................................. 10 1.7 Purpose of the study ................................................................................................. 13 Chapter 2: Methods .................................................................................................................. 14 2.1 Study overview .......................................................................................................... 14 2.2. Inclusion and exclusion criteria ................................................................................ 15 2.2.1 Recruitment .......................................................................................................... 15 2.3 Data collection instruments ....................................................................................... 16 2.3.1 Demographic survey ............................................................................................ 16 2.3.2 Accelerometer ...................................................................................................... 17 viii 2.3.3 Activity log ............................................................................................................ 17 2.4 Accelerometer data processing ................................................................................. 18 2.4.1 Wear time validation ............................................................................................. 18 2.4.2 Physical activity intensity classification ................................................................ 18 2.4.3 Time Filters .......................................................................................................... 19 2.5 Assessing adherence with the MVPA guidelines and DPA School Policy ................ 20 2.6 Interviews .................................................................................................................. 20 2.6.1 Interview guide ..................................................................................................... 21 2.6.2 Interview administration ....................................................................................... 21 2.7 Data Analysis ............................................................................................................ 22 2.7.1 Statistical analysis ................................................................................................ 22 2.7.2 Qualitative analysis .............................................................................................. 23 2.7.2.1 Positionality ................................................................................................... 23 2.7.2.2 Inductive thematic analysis ........................................................................... 23 2.7.2.3 Deductive analysis ........................................................................................ 25 2.8 Data storage .............................................................................................................. 25 Chapter 3: Results .................................................................................................................... 27 3.1 Participants’ characteristics ....................................................................................... 27 3.2 Daily moderate-to-vigorous physical activity (Daily MVPA) ....................................... 28 3.3 School moderate-to-vigorous physical activity (School MVPA) ................................. 30 3.4 Physical education based moderate-to-vigorous physical activity (P.E. MVPA) ....... 32 3.5 Total Daily Physical Activity ....................................................................................... 32 3.6 Comparison of PA between sensory and physical disability groups ......................... 34 3.7 Qualitative results ...................................................................................................... 36 3.7.1.1 Importance of the staff ................................................................................... 37 3.7.1.2 Importance of task ......................................................................................... 38 ix 3.7.1.3 Teaching self-advocacy ................................................................................. 40 3.7.1.4 Need to look outside of the school ................................................................ 40 3.7.2 Quality Participation ........................................................................................................ 42 3.7.2.1 Autonomy ...................................................................................................... 42 3.7.2.2 Belongingness ............................................................................................... 44 3.7.2.3 Challenge ...................................................................................................... 45 3.7.2.4 Engagement .................................................................................................. 46 3.7.2.5 Mastery .......................................................................................................... 47 3.7.2.6 Meaning ......................................................................................................... 48 Chapter 4: Discussion .............................................................................................................. 52 4.1 Summary of the findings ............................................................................................ 52 4.1.1 Daily MVPA .......................................................................................................... 53 4.1.2 School MVPA ....................................................................................................... 54 4.1.3 P.E. MVPA ........................................................................................................... 55 4.2 Quality participation ................................................................................................... 57 4.3 Strengths and limitations ........................................................................................... 60 Chapter 5: Conclusion .............................................................................................................. 63 References ................................................................................................................................ 65 Appendices ................................................................................................................................ 72 Appendix A .......................................................................................................................... 72 Appendix B .......................................................................................................................... 79 Appendix C .......................................................................................................................... 80 Appendix D .......................................................................................................................... 96 Appendix E ........................................................................................................................ 101 x List of Tables Table 1 Demographic characteristics ...................................................................................... 27 Table 2 Demographic information of the study sample ........................................................... 28 Table 3 Individual and group mean Daily MVPA .................................................................... 30 Table 4 Individual and group mean school MVPA .................................................................. 31 Table 5 Individual and group mean P.E. based MVPA ........................................................... 32 Table 6 Individual and group mean Daily PA .......................................................................... 33 Table 7 Comparison of PA between sensory and physical disability groups .......................... 35 Table 8 Quality participation positive elements ....................................................................... 50 Table 9 Quality participation negative elements ..................................................................... 51 xi List of Figures Figure 1 Geographical distribution of study participants ........................................................ 28 Figure 2 Individual mean daily MVPA .................................................................................... 29 Figure 3 Individual mean school-based MVPA ...................................................................... 31 Figure 4 Individual level Total Physical Activity ..................................................................... 34 xii List of Abbreviations ASD Autism Spectrum Disorder BC British Columbia CAPE Children’s Assessment of Participation and Enjoyment CAWD Children and Adolescents with Disabilities CI Confidence Interval CHMS Canadian health Measure Survey DPA Daily Physical Activity DYT Deaf Youth Today FNDC Family Network for Deaf Children ICF International Classification of Functioning, Disability and Health IDD Intellectual and Developmental Disabilities INC Incomplete LPA Light Physical Activity MARCA Multimedia Activity Recall for Children and Adolescents MVPA Moderate-to-Vigorous Physical Activity NPAM National Physical Activity Measurement Project PAPP Physical Activity Parental perception PA Physical Activity P.E. Physical Education PHE Physical and Health Education QP Quality Participation REDCap Research Electronic Data Capture SCI Spinal Cord Injury TPA Total Physical Activity UBC The University of British Columbia xiii WHO World Health Organization xiv Acknowledgements It seems that not so long ago I was writing an email to Dr. Kathleen Martin Ginis. It took me hours to come up with something more than Hi, I would like to be part of your lab. Kathleen, since the first day we met, your support has been a constant source of encouragement. Having the opportunity to learn from you is something I will always be grateful for. I am proud of the story we are going to share with this project. I would like to thank my Co-supervisor Dr. Christine Voss for taking me on this wonderful journey with the Voss lab, constant brainstorm, and enthusiastic encouragement. It was a pleasure working with you. I would like to acknowledge my Thesis committee members: Dr. Heather Gainforth and Dr. Kelly Arbour-Nicitopoulos. I appreciate your input, guidance, and thoughtfulness throughout the course of my Masters. To the SCI Action Canada lab - Femke, Rob B, Cam, Sarah, Matteo, Rob S, Kenedy, Ava, Nate, Kierstyn and Ken. I feel truly fortunate to be part of such a talented and compassionate awesome group of people. Each of you has contributed to my professional and personal development, and I am humbled by the wealth of knowledge and experience I have gained from our interactions. I would like to extend my heartfelt gratitude to the exceptional Voss lab team for their support and encouragement during the entirety of this project. Thank you all for making this an unforgettable experience. CHBC – Your positive energy, personalities, and the joy of small talks and laughter make our Center a uniquely enjoyable space where we can thrive both personally and professionally. Thank you for being Happy People and making our work all the more special. xv Lastly, I owe the biggest gratitude to my family and friends from Belgrade to Kelowna, for their unwavering love and support, which has been a constant source of strength throughout my journey(s). Not all who wander are lost. xvi Dedication This thesis is dedicated to the children and their parents who generously and wholeheartedly participated in this study by sharing their personal stories. Their contributions have been invaluable, not only in providing essential data but also in challenging my perspective and inspiring me to explore new ways of thinking. Their willingness to share their experiences has enriched this research and played a crucial role in shaping its outcomes. I express my deepest gratitude to these families, whose openness and trust have been instrumental in the development of this thesis. 1 Chapter 1: Introduction 1.1 Disability defined Disability is an evolving concept. Social models of disability conceptualize disability as a result from the interaction between persons with impairments, and attitudinal and environmental barriers that hinder their full and effective participation in society on an equal basis with others (United Nations Convention on the Rights of Persons with Disabilities, 2006). According to the World Health Organization (International Classification of Functioning, Disability and Health (ICF) Geneva 2001) disability has three dimensions: 1. Impairment in a person’s body structure or function, or mental functioning; examples of impairments include loss of a limb, loss of vision or memory loss. 2. Activity limitation, such as difficulty seeing, hearing, walking, or problem solving. 3. Participation restrictions in normal daily activities, such as working, engaging in social and recreational activities, and obtaining health care and preventive services. 1.2 Epidemiology 1.2.1 Children with disabilities in Canada The Canadian Survey on Disability (Cloutier, 2018) provides a comprehensive definition of disability, highlighting the dynamic interaction between an individual's functional limitations and environmental barriers. This definition encompasses both social and physical obstacles that hinder day-to-day functioning, recognizing that disability is influenced by external factors. Sensory disabilities, such as vision and hearing impairments, are included in this definition. According to the Canadian Health Measures Survey (CHMS) conducted by Statistics Canada, 2 2.6% of children aged 6 to 19 have a visual impairment, while 8% have slight or worse hearing loss (Government of Canada, 2015). A physical disability is characterized by limitations in functional abilities resulting from impairments in the neurological and/or musculoskeletal systems. The most common physical disabilities among children living in Canada can vary depending on numerous factors such as the age group, geographic region, and specific population studied. However, some of the commonly reported physical disabilities in children in Canada include cerebral palsy, muscular dystrophy, spina bifida, and osteogenesis imperfecta. Currently, 3.7% of Canadian children and youth (<15 years old) report having a disability, of which 11% have a physical disability (Bélair, 2007). These statistics highlight the prevalence of disability among Canadian children and youth, underscoring the importance of understanding and addressing the challenges they face in their daily lives. The focus of my thesis is on children with physical and/or sensory disabilities residing in British Columbia. These disabilities encompass a wide range of conditions that can affect mobility, sensory perception (such as vision or hearing), or a combination of both. By narrowing down the scope of my thesis to this specific population in British Columbia, I aim to explore and understand their participation in PA, particularly during P.E. It is important to study this particular group as children with physical and/or sensory disabilities face unique challenges and barriers when it comes to engaging in PA and accessing the quality of P.E. By examining their experiences, barriers, and facilitators, we can gain valuable insights into developing effective strategies and interventions to promote their active participation. It is essential to ensure that all children, regardless of their abilities, have equal opportunities to participate and thrive in PA and P.E., ultimately contributing to their overall physical, social, and emotional development. 3 1.3 Physical activity levels of children with disabilities in Canada According to the WHO Guidelines on Physical Activity and Sedentary Behaviour, ) children, and adolescents (5 to 17 years old) should do at least an average of 60 minutes per day of MVPA, mostly aerobic, physical activity, across the week. This recommendation is also supported by The Canadian 24-Hour Movement Guidelines for Children and Youth. However, despite these recommendations and the known benefits of PA, the majority of Canadian children and youth are insufficiently active. Nearly 40% of children and youth aged 5 to 17 met the physical activity target (Colley, 2017). Less is known about the PA levels of Canadian children and youth with disabilities. The Canadian Para Report Card on Physical Activity for Children and Adolescents with Disabilities (CAWD) (Arbour-Nicitopoulos, Kuzik, et al., 2022) was a project undertaken with the purpose to evaluate and provide a comprehensive summary of PA data for children and adolescents with disabilities. The report card summarized and evaluated data from four national population-level datasets. Several stakeholders were included in data gathering and evaluation: a panel of researchers, representatives from disability organizations and parents of children and adolescents with disabilities. All of them graded thirteen indicators of PA participation through a disability-specific lens. The grades were based on criteria set by the Global Matrix 4.0, the largest compilation of children’s and adolescents’ PA indicators to date (Aubert et al., 2022). The grades could range from A to F (A – excellent; B – good; C – satisfactory; D – marginal; F - fail) and INC for incomplete. The findings were summarized in The Report Card (Arbour-Nicitopoulos, Kuzik, et al., 2023) which indicated that overall, these individuals were engaging in inadequate levels of PA. A study by Arbour-Nicitopoulos et al. (2021) provided a more detailed analysis of PA in this population. The study included fifty-four participants, aged 12 to 21 years, consisting of 22 boys 4 and 32 girls with physical and/or sensory disabilities. The researchers utilized the Multimedia Activity Recall for Children and Adolescents (Ridley et al., 2006), a self-report tool, to gather data on the participants' movement behaviors over a 24-hour period. The results revealed that, on average, the participants spent 77 minutes per day engaging in MVPA, 252 minutes engaging in sedentary activity, and 546 minutes sleeping. These findings indicated insufficient levels of PA and excessive sedentary behavior among the participants. Moreover, only a small percentage (3.7%) of the sample met all three movement guidelines, highlighting the low adherence to recommended PA levels. These findings underscore the importance of addressing PA disparities and promoting active lifestyles among children and adolescents with physical and/or sensory disabilities. The study contributes to the understanding of their specific movement behaviors and serves as a call to action for implementing interventions and strategies to improve their PA levels and overall health outcomes. The CAWD Report Card also noted the lack of national surveillance data on PA patterns during school time for children and youth with disabilities. This is because in many studies, children with disabilities are often excluded or their data are simply not reported. The Canadian Para Report Card determined the grade for PA participation during P.E. as “incomplete.” For the majority of Global Matrix 4.0 benchmarks (four out of six), P.E. data was not available. This indicates ample room for data collection in this area and need for research to better understand participation in P.E. for children and youth with disabilities. 1.4 Factors influencing participation in physical activity by children with disabilities It has commonly been assumed that participation in PA among children with disabilities differs across a diverse range of factors. Bloemen et al (2015) investigated factors that hinder 5 and/or facilitate PA for children and adolescents with physical disability. They reported that PA was positively associated with self-efficacy, physical fitness, increasing age and the availability of equipment and local facilities, with increasing age an important barrier specific to children and adolescents with physical disabilities. Martin Ginis et al. (2016) conducted a configurative review aiming to synthesize the literature on factors influencing PA participation among children and adults with physical disabilities. Their comprehensive examination revealed that key factors associated with PA participation are distributed across multi-level and multi-sector structures. These factors can be categorized into different levels: individual (self-efficacy, motivation, perceived competence, personal preferences, disability-specific), interpersonal (social support, caregiver support, peer influence, role modeling, attitudes, and beliefs), environmental (accessibility of facilities, availability of equipment, safety, proximity of facilities, built environment), and policy-level factors (inclusive policies, funding and resources, education policies, transportation options, advocacy, and awareness). This categorization provides a framework for understanding the complex interplay of factors influencing PA engagement in individuals with physical disabilities. Research on these factors can provide valuable insights for health professionals, teachers, policy makers, and sports clubs, enabling them to develop effective interventions aimed at increasing PA participation among children with physical disabilities. It is essential to move beyond descriptive studies and focus on the development, implementation, and evaluation of new interventions, as emphasized by Martin Ginis et al. (2016) the interaction and influence of these factors at various levels shape the opportunities and barriers faced by individuals with physical disabilities in engaging in PA. By understanding these dynamics, tailored strategies can be designed to promote inclusive and accessible PA environments, fostering greater participation among this population. 6 A few studies have examined the reasons for low activity levels among Canadian children with physical or sensory disabilities. An example of this study is the research carried out by Law et al. (2006) which sheds light on the reasons for low activity participation among children with complex physical disabilities. The Children’s Assessment of Participation and Enjoyment (CAPE) (King et al., 2007) was used as a measure and data were collected from 427 participants. One significant finding was that participation in PA significantly decreased as children with physical disabilities grew older, particularly among those aged 12 years and older. This suggests that there may be specific challenges or barriers that emerge as children transition into adolescence and beyond, leading to a decline in their engagement in PA. Furthermore, the research highlighted those children with physical disabilities tended to be more involved in informal physical activities rather than formal physical activities. Informal activities may include play or recreational activities within their immediate environment, such as engaging in physical play with siblings or friends at home or in the community. On the other hand, formal activities encompass organized sports, structured exercise programs, or activities conducted within a structured setting or under the guidance of a trained instructor. 1.5 School-based Physical Activity and Physical Education According to Statistics Canada (Directly Measured Physical Activity of Children and Youth in 2012, 2013, and 2015) 37% of 5- to 11- years-olds in Canada performed at least 150 minutes of PA per week during class time at school. Only 36% of 12- to 17-year-olds reported at least 150 minutes of PA per week during class time and free time at school (Hatfield & Chomitz, 2015).Together, these data suggest that about one-third of Canadian school-aged children achieve the WHO- and Canadian-recommended levels of PA through their activities at school. The Daily Physical Activity (DPA) policy in British Columbia (Daily Physical Activity Kindergarten to Grade 12 Program Guide (Updated 2011) Ministry of Education) is a requirement for elementary schools to ensure that students engage in a minimum of 30 minutes 7 of PA on school days, regardless of whether there is a scheduled P.E. class or not. The policy statement has undergone revisions by the BC Ministry of Education over time to refine its implementation. Notably, in 2011, a significant change was made, eliminating the distinction between P.E. and non-P.E. days. This means that the requirement of 30 minutes of DPA applies consistently to all school days, regardless of whether there is a scheduled P.E. class or not. By removing the division between P.E. and non-P.E. days, the policy emphasizes the importance of regular PA as an integral part of a student's daily routine, beyond the confines of formal P.E. classes. This revision acknowledges that PA can and should be incorporated throughout the school day, during both instructional and noninstructional time. The overall objective of the DPA policy in British Columbia is to assist students in meeting the Canadian 24-hour Movement Guidelines Physical Activity Guidelines, which recommend 60 minutes of MVPA per day. Although the policy statement itself does not specify the intensity of PA, its purpose aligns with the goal of achieving this recommended level of activity. For elementary schools in British Columbia, it is mandated that students in grades K-9 receive at least 30 minutes of PA as part of the educational program on days when there is no scheduled P.E. class. This requirement ensures that students in the elementary grades have regular opportunities for PA, even if there is no dedicated P.E. period on a particular day. According to The Ministry of Education for the Province of British Columbia, 74% of schools did not meet the minimum 10% of instructional time designated for physical education (Deacon, 2001). School-based PA, including P.E., recess and active play are one of the main ways in which children could meet the DPA recommendations. However, minimal research in Canada has examined the process of how new DPA policy plans are translated and implemented. Furthermore, there is a lack of available data on how and in what type of settings, 8 children in British Columbia schools are achieving PA guidelines. Even less is known about British Columbia school-based PA participation among children with disabilities. Understanding the level of participation and the factors influencing PA engagement among this population is crucial for developing inclusive interventions and promoting equitable opportunities for PA within the school setting. Given these research gaps, further investigation is needed to explore the translation and implementation of DPA policies, as well as to gather data on PA levels and experiences among children in British Columbia schools. Additionally, focused attention should be given to examining school-based PA participation among children with disabilities to ensure their inclusion and equitable access to PA opportunities. Public health recommendations highlight the central role that schools play in providing equitable opportunities for PA for all children (Hatfield & Chomitz, 2015). Given that P.E. is part of the core curriculum in British Columbia school programs, there is a need to provide better insight on the school-based activity levels of children with disabilities. This information is important for the purposes of PA and health promotion (Tremblay et al., 2016). It is also essential to understand the context in which children with children with disabilities experience P.E., and to examine factors that support their PA participation (Hatfield & Chomitz, 2015). Such information can be used to support schools in providing equitable P.E. opportunities for children with disabilities. Within the field of P.E. for children with physical and/or sensory disabilities, there are numerous studies conducted in other counties covering the experience, PA level and participation. For the purpose of this research question and study, I will focus my research literature review on P.E. studies conducted in Canada. Few studies have explored the experience of children with physical disabilities participating in inclusive P.E. in Canada. Goodwin & Watkinson (2000) were one of the first 9 authors to describe inclusive P.E. from the perspective of students with physical disabilities. Data was gathered through focus group interviews, participants’ drawings, and field notes. Data was triangulated to gain a broader view of the setting. Thematic summary of the inclusive P.E. perspective provided insight into what contributes to positive and less than positive experiences for students with physical disabilities. Students categorized their experiences as good days and bad days. Good days were characterized as providing a sense of belonging, opportunities to share in the benefits, and to demonstrate skillful participation. For example, good days were when children were fully included in lessons. Bad days were characterized as competence questioned, social isolation, restricted participation. For example, bad days in P.E. were when children felt socially isolated by their classmates. Overall, this study concluded that children enjoyed P.E. when they were engaged in PA. Furthermore, to better understand the meaning of helping behaviour and influence on motivation and dependency states in P.E. classes among students with physical disabilities, Goodwin (2001) used a maximum variation sampling strategy with the aim to collect data from the widest range of perspectives possible. Similar to the previous study, data were collected from interviews, visual documentation, and field notes. The data were analyzed into thematic statements. The behavior of classmates towards the participants was found to comprise a combination of positive and negative self-related information. Classmate behavior was considered supportive when it included caring messages, helped the participants succeed in their activities, and encouraged self-reliance. On the other hand, classmate behavior was considered self-threatening when it emphasized dependency, making the participants feel inferior in comparison. 10 1.6 Quality Participation The term “participation” is defined by the WHO (World Health Organization, International Classification of Functioning, Disability and Health, Geneva 2001) as the nature and extent of a person's involvement in life situations and includes activities of self-care, mobility, socialization, education, recreation, and community life. Efforts to understand P.E. participation of children with disabilities must differentiate between being physically active during P.E. classes and merely being marked as “present” on the attendance list. Imms et al., (2016) have referred to this as distinguishing between “attendance” and “involvement”. Within the context of PA and disability, researchers have made similar distinctions between “quantity” and “quality” of participation. Martin Ginis et al. (2017) conducted a configurative review of papers emphasizing the participation definitions and experiences among persons with physical disabilities. Ten articles were included in the final review stage. Using inductive thematic analysis, the authors formulated six experiential aspects of participation beyond physical performance: autonomy, belonginess, challenge, engagement, mastery and meaning. The review stipulates that these six qualitative aspects of participation, as well as quantitative aspects, should be include ed when it comes to participation conceptualization and definitions. Building from the Martin Ginis et al. (2017) conceptualization of participation aspects in individuals with disabilities, Evans et al. (2018) aimed to develop a Quality Parasport Participation Framework for optimal parasport participation. After establishing the scope for the framework and synthesizing existing knowledge, over 120 research users were involved in the framework development. The framework was utilized to identify the categories of conditions that shape the quality of sport experience for individuals with disabilities. As a result, Evans et al. (2018) concluded that three conditions — physical environment, activities and social environment have a key role in enabling the quality sport participation for 11 individuals with disabilities. These conditions shape individuals' quality experiences, which reinforce quality participation (e.g., autonomy, belongingness, challenge, engagement, mastery and meaning). In turn, quality participation has long-term physical, psychological, and social outcomes. A cross-sectional study by Arbour-Nicitopoulos, Bruno et al. (2022) examined the factors contributing to quality sport experiences for youth (ages 12-24) participating in Special Olympics. The researchers surveyed 451 athletes involved in the 2019 Special Olympics Youth Games, assessing elements of quality participation — autonomy, belongingness, challenge, engagement, mastery, and meaning. The study explored whether athletes with intellectual and developmental disabilities rated these elements differently across Traditional and Unified Sport programs. The results showed that youth reported high mean scores across all elements, with no significant differences between athletes with and without disabilities in Traditional or Unified Sport. However, athletes without reported disabilities rated higher in autonomy than those with disabilities, and women tended to report greater engagement in sports compared to men. A review done by Bruno et al. (2022) aimed to explore the participation experiences of children with intellectual and developmental disabilities (IDD) to understand the concept of quality participation for them. The researchers used a systematic scoping review methodology and included a total of 35 articles that met the criteria. From the data, the researchers identified 30 quality participation strategies and 8 outcomes. These strategies and outcomes were categorized into six experiential elements: autonomy, belongingness, challenge, engagement, mastery, and meaning. The research contributes to a better understanding of the importance of quality participation as a significant life outcome for children with intellectual and developmental disabilities. Another study by Streatch et al. (2023) focused on promoting quality sport experiences for children with autism spectrum disorder (ASD). Children with ASD often face barriers to sport participation, leading to lower levels of engagement compared to their peers without disabilities. 12 The researchers investigated priorities and strategies to foster quality participation for children with ASD in sport programming. The study involved caregivers, volunteers, and staff who were part of sport programs for children with ASD. They rated experiential elements of quality participation using the Measure of Experiential Aspects of Participation. Additionally, a two-round Delphi survey with staff generated 22 strategies aimed at promoting quality participation, all of which were considered highly important (rated 5.69-6.85 on a 7-point scale). These strategies were supported by published research evidence. Based on the findings, the researchers developed a quality participation tool to assist instructors in implementing the identified strategies, with the goal of improving sport experiences for children with ASD. By addressing the specific needs and challenges faced by these children, the study aimed to enhance their physical and psychosocial well-being and encourage long-term engagement and enjoyment in sports. It is important to highlight that the existing studies on quality participation in children have primarily focused on these specific populations, and no research has been conducted on children with physical and/or sensory disabilities or their experiences in P.E. classes. Consequently, there is a notable research gap concerning these aspects, which I intend to address in my thesis to contribute to the broader understanding of quality participation in diverse groups of children. The current understanding of how school-based PA programs, whether instructional or non-instructional, cater to children and youth with disabilities, and facilitate their full and effective participation is limited. It remains uncertain whether these programs adequately accommodate individuals with varying abilities. Therefore, there is a pressing need to investigate and comprehend the extent to which school-based PA programs, P.E. classes, provide quality experiences for children and youth with disabilities. By gaining insights into these aspects, we 13 can work towards creating more inclusive and empowering PA environments for all individuals, regardless of their abilities. 1.7 Purpose of the study Research suggests that school-aged individuals with disabilities who regularly participate in physical activity can decrease the chances of developing health-related issues through their life span (Rimmer et al., 2007). School-based PA policy may be a promising approach to help children with disability enhance their health and well-being and achieve the PA recommendations. The structured environment of the P.E. class may offer children with disabilities a means for the systematic promotion of their enjoyment, opportunities to gain experience and practice motor skills. To our knowledge, no studies have explored the lived PA and P.E. experiences of children with physical and/or sensory disabilities in British Columbia. It is also unknown if children with physical and/or sensory disabilities experience quality participation in P.E. situations in British Columbia. Therefore, the purpose of this study is to explore the lived experiences of children with physical and/or sensory disability to develop a deeper understanding about children’s participation in P.E. classes. The specific objectives of the thesis are: 1) To measure the daily amount of PA among children with physical and/or sensory disabilities. 2) To measure the amount of where and in what type of settings they have organized P.E. activities. 3) To describe their participation experiences during P.E. classes. 14 Chapter 2: Methods 2.1 Study overview In order to explore PA behaviors in children with physical and/or sensory disabilities, an exploratory, sequential, mixed-method study design was employed. This approach involves the use of both quantitative and qualitative methods, which are applied independently and later combined to complement each other. By utilizing this design, a deeper insight into the participation of these children in PA during school time and P.E. classes was sought. Data for the study were collected through three primary methods: a questionnaire, accelerometer measurements, and interviews. The questionnaire was utilized to gather information about the child's disability, DPA patterns, and activities both within and outside of the school setting. Accelerometers were used to measure the PA levels of the children. Interviews were conducted to gain a deeper understanding of the participants' perspectives on their experiences with P.E. participation. The mixed-method approach was chosen to access and analyze data from multiple perspectives, allowing for a more comprehensive understanding of the PA participation of children with physical and/or sensory disabilities. The study was conducted with children aged 7-15 years old in British Columbia, Canada. Both quantitative and qualitative methods were used independently during the data collection phase, but their results were later combined in the Discussion section to aid interpretation and gain a comprehensive understanding of the research questions and issues to be focused on in future studies. It is important to note that participating families underwent a comprehensive study protocol as part of a larger research study. Only the methods and results relevant to the specific research questions of this thesis are presented and discussed. Ethical approval for the study was obtained from The University of British Columbia Okanagan Behaviour Research Ethics Board (H22-00842), ensuring that the research adhered to ethical guidelines and prioritized the rights and well-being of all participants. 15 2.2. Inclusion and exclusion criteria The inclusion criteria for participants in the study were established to ensure that the participants met specific characteristics or qualifications relevant to the research topic. To be eligible for participation in the study, participants had to meet the following inclusion criteria: 1) have a physical and/or sensory disability, according to WHO, International Classification of Functioning, Disability and Health, Geneva (2001); 2) Be between 7 and 15 years old; 3) reside in British Columbia; 4) Attend school (public or private); and 5) Participate in P.E. classes. Typically developed children and those who were home-schooled were excluded from participating in the study. 2.2.1 Recruitment The recruitment process involved reaching out to potential participants through various channels. An online flyer describing the study and its inclusion criteria was circulated among individuals who had previously agreed to be contacted for future research opportunities through the National Physical Activity Measurement Project (NPAM) (Arbour-Nicitopoulos, Mitra, et al., 2023). Additionally, emails were sent to eleven provincial disability organizations that provide community-based support for families and children with disabilities. Notably, participants were successfully recruited through the Family Network for Deaf Children (FNDC), Deaf Youth Today (DYT), BCBlind, and Wheelchair Basketball Kelowna. The study was also advertised on the REACH BC website (Reach BC), a platform that connects British Columbians with opportunities to participate in health research. Furthermore, recruitment flyers were posted through social media channels (Facebook and Twitter) and displayed in recreational facilities around Kelowna and Vancouver, as well as in BC Children's Hospital. Once individuals expressed interest in participating, they were directed to contact the researcher. The recruitment and data collection period for this study spanned from November 2022 to May 2023. 16 The participants and their parents/guardians were provided with a written electronic consent form for parent/guardian and assent for children, along with an age-appropriate script explaining the study procedure for child’s understanding (See Appendix A and B for parents’ consent forms, child assent form). An online survey tool called Qualtrics, available through the University of British Columbia (UBC), was utilized to collect consent and assent. Upon obtaining consent and assent forms from both parent/guardian and child, a survey link was sent to collect demographic information to determine the eligibility. 2.3 Data collection instruments 2.3.1 Demographic survey The first section of the questionnaire included questions pertaining to the participants' eligibility based on the inclusion and exclusion criteria, such as age, disability status, and school attendance (See Appendix C for full demographic survey). The parent or guardian demographic section also encompassed questions regarding the child's self-identified gender, the relationship to the child, education level, household income and ethnicity. Other relevant factors were use of mobility aids, transportation to and frequency of child’s participation in PA outside of school. The subsequent segment of the survey focused on exploring PA parenting practices whereby parents completed a comprehensive survey - the Physical Activity Parental Perception (PAPP) (Mâsse et al., 2020). Selected data from PAPP survey is presented in the thesis. Parents were prompted to rate their level of support and involvement in their child's PA pursuits. This involved assessing the frequency and manner in which parents engage in PA together with their child. This set of questions in this survey section aimed to explore their involvement in their child's PA pursuits. 17 2.3.2 Accelerometer Upon receiving the completed demographic questionnaire and confirming the participants' eligibility, participants were mailed an accelerometer (wGT3x-BT tri-axial accelerometer, ActiGraph, Pensacola, USA). The ActiGraph device, compact in size, measures approximately 4.5 x 3.3 x 1.5cm and weighs around 19g. This specific model of ActiGraph displays a triaxial motion sensor capable of capturing acceleration in multiple planes. To start data recording, the devices were initialized using the ActiLife software (ActiLife v6.13.4, ActiGraph, Pensacola, USA) and were set to begin recording at a specific time and end at a predetermined time. To allow for postage delays, a grace period of at least two days was implemented after the device started recording. Additionally, both parent and child were provided with clear instructions on how to wear the ActiGraph device. Specifically, they were advised to secure it on a belt positioned at their right hip, ensuring it remained in place throughout their waking hours for a continuous duration of 7-day period. They were instructed to remove the device during activities such as bathing or swimming to prevent any water damage. After the 7-day wear period of the ActiGraph devices, participants returned the device to the research team, along with an activity log via prepaid envelope. Once the ActiGraph devices were returned to the research team, the recorded data was downloaded and analysed. 2.3.3 Activity log To capture additional contextual information about the child’s daily activities, parents or caregivers were requested to complete an activity log during the 7-day period when the measurement device was worn. The activity log was conveniently included in the mailing package along with the ActiGraph device. The activity log consisted of paper forms where parents could document specific details regarding the wear times and removal of the device (See Appendix D for activity log). Parents were instructed to record the exact time when the ActiGraph device was 18 put on and taken off each day. Parents were also specifically prompted to note the start and end times of the child's P.E. class, if applicable, during school days. 2.4 Accelerometer data processing The software ActiLife 6 Version 6.13.4 was utilized for the download, processing, and analysis of the accelerometer data. Raw GT3X files were downloaded and transformed into AGD files with a 15-second epoch. The decision to employ a 15-second epoch was made because it was used to calibrate the cutpoints used to classify PA intensities in this thesis. It is worth noting that the choice of sampling epoch may vary depending on the research objectives, population under study, and available resources. Researchers consider factors such as the age group, type of activity being measured, and the desired level of precision when determining the appropriate sampling epoch. In this case, the decision to use a 15-second sampling epoch aligns with the aim of capturing the sporadic nature of children's activity and was informed by previous research in the field. 2.4.1 Wear time validation The wear time validation function in ActiLife software was employed to determine the wear time of the accelerometer. A day was valid if the participant wore the device for a minimum of 600 minutes per day (Adamo et al., 2009), over the four days (one day of weekend included) (Carson & Janssen, 2011). Non-wear time was defined as a period of >60 minutes of zero counts, with a spike tolerance of up to 2 minutes of <100 counts per minute (Troiano et al., 2008). 2.4.2 Physical activity intensity classification The Evenson cutpoints were utilized in this study to assess the daily mean duration of light physical activity (LPA) and MVPA in minutes. These cutpoints, are a set of specific thresholds developed by Evenson et al. (2008) for classifying activity intensity levels in children. For MVPA, an accelerometer count threshold of 2296 axis 1 counts per minute was applied. Any 19 accelerometer readings equal to or above this threshold were considered indicative of MVPA, where LPA was counted as an axis 1 count between 100 and 2295. It's important to note that different studies or research groups may use different sets of cutpoints depending on their specific research objectives and populations. The Evenson cutpoints have been widely utilized in research involving children due to their validation and recommendation for accurately classifying activity intensity levels in this population (Evenson et al., 2008). 2.4.3 Time Filters To determine the duration of PA during school hours an P.E. classes, the researchers utilized the Global date and Time Filters function available in ActiLife software. This feature allowed for precise processing of the collected data based on the school bell schedule. By synchronizing the ActiGraph devices with the school's time schedule, collected from schools’ websites, we identified the start and end times of PA occurring during school hours. The ActiLife software's Global date and Time Filters function enable to filter out non-school hours and focus specifically on PA that took place during the designated school time. By employing this feature, they could exclude any PA occurring before or after school, ensuring that the analysis focused solely on the targeted time frame. Daily MVPA was calculated by computing the mean MVPA across all the days for which data was recorded. For school-based MVPA, the calculation was specifically focused on school days. The mean MVPA for these school days was calculated and presented as mean values, providing an overview of the participants' PA levels during their time at school. If participants had P.E. classes more than once a week, the mean MVPA was calculated between these classes. This approach allowed researchers to capture the average PA level of the participants during multiple P.E. classes. 20 2.5 Assessing adherence with the MVPA guidelines and DPA School Policy To assess whether the children met the physical activity recommendations within the overall 24-hour Movement Guidelines, the average time spent in MVPA was considered. According to these guidelines, children are recommended to accumulate an average of 60 minutes of MVPA per day (The Canadian 24-Hour Movement Guidelines for Children and Youth). Mean daily MVPA (min/day) was used to determine if participants achieved recommended level of physical activity. In the school setting, we also assessed whether the children met the DPA school policy, which specifically focused on instructional and non-instructional time during the school day. Mean Daily school-based MVPA (min/day) was used to determine if participants met the DPA school policy, which required the accumulation of 30 minutes of MVPA during these designated school periods (Daily Physical Activity Kindergarten to Grade 12 Program Guide (Updated 2011) Ministry of Education). 2.6 Interviews In the qualitative component of this study, semi-structured interviews were conducted with both parents and children. The information obtained from the interviews served as complementary data to the questionnaire responses and accelerometer data. This integration allowed for a more comprehensive analysis and interpretation of the findings. The interviews were conducted after the primary author had inspected the questionnaire, activity log and accelerometer data in order to engage with the participants from an informed perspective. The interviews were conducted separately for parents and children, with the parent present during the child's interview. The interviews were conducted via institutional UBC Zoom. Participants were provided with a unique Zoom link that required a passcode to join the meeting. Participants had the option to keep their cameras turned off during the interview. The Zoom 21 interviews were audio-recorded and automatically transcribed using Zoom's transcription feature. 2.6.1 Interview guide The semi-structured interview format allowed for a flexible and interactive conversation, guided by a pre-developed interview guide with open-ended questions (See Appendix E for interview guide). The interviews aimed to gather in-depth information about the experiences, perspectives, and challenges related to PA participation in this specific population. By conducting separate interviews with parents and children, the study aimed to capture the unique perspectives of both parties involved in the child's PA participation. The interview guide allowed for flexibility and interaction during the interviews, enabling the interviewer (A.J) to engage with the participants and delve deeper into their experiences of PA participation. This approach ensured that the interview topics were relevant to the participants' experiences and perspectives. The guide covered various aspects related to PA, including the child's involvement in PA during and after school, the parent's role in stimulating their child's participation, and the child's experiences in organized PA, such as P.E. classes. The questions were carefully designed to capture children's experiences and understand their engagement and enjoyment in P.E. Furthermore, questions aimed to explore the children's perspective on their P.E. experiences, their preferences, and the challenges they faced during these classes. 2.6.2 Interview administration Parents were interviewed first, during which they were asked questions about their experiences with their child's participation in PA, both during and after school. They were also asked about their role in stimulating and supporting their child's participation in sports and other PA. After the parent interview, the child was interviewed in the presence of their parent. The 22 child was asked to share their experiences of participating in organized PA in school, such as P.E. classes. They were also asked about how their disability either included or excluded them from participation in these activities. The goal was to gain insights into the child's perspective on their PA experiences and any barriers they may face. To identify the presence or absence of quality participation among children with physical and/or sensory disabilities, participants were also asked if they had ever been excluded from participating, how that made them feel, and whether activities were organized in a way that enabled their participation. 2.7 Data Analysis 2.7.1 Statistical analysis Descriptive statistics were generated to summarize the variables of interest. The specific type of descriptive statistics used (number, mean, standard deviation, or median with interquartile range) depended on the nature and distribution of the data. Histogram plots were examined to assess the normality of continuous variables visually. In order to compare the PA levels between children with sensory disability and children with physical disability, linear regression models were used. However, during the data analysis process, a challenge was encountered with participant P4. This participant did not have recorded accelerometer data, which meant that their quantitative PA information was missing. To maintain the validity and accuracy of the statistical analysis, this participant was excluded from the quantitative analysis. Data management and analysis were conducted using SPSS (version 28.0, Statistical Product and Service Solutions, Chicago, USA) and The R Project for Statistical Computing (version 4.2.3, RStudio, Vienna, Austria). 23 2.7.2 Qualitative analysis 2.7.2.1 Positionality As a researcher in this project, I am a woman without disabilities and a P.E. teacher with prior experience working with children who have disabilities. While my background in P.E. has shaped the research questions towards inclusivity, I acknowledge that I do not have firsthand experience as a child with disabilities or as a parent of a child with disabilities. Understanding the significance of positionality, I engaged in self-reflection throughout the study to recognize and address any potential biases that might influence the research. I adopted Braun and Clarke's thematic analysis approach to systematically identify themes in the data, ensuring that my interpretations are firmly rooted in the participants' experiences. By being transparent about my positionality, I aimed to maintain objectivity and respect for the participants' perspectives. Overall, I committed to conducting this research with sensitivity, awareness, and openness, aiming to contribute valuable and respectful insights into the experiences of children with disabilities in P.E. settings. 2.7.2.2 Inductive thematic analysis The recorded interviews were transcribed and converted into electronic forms (Adobe PDF). All coding was done by hand (no software was used). Before analyzing the data, the transcripts were carefully checked for any ambiguous or incomplete words to ensure accuracy. Transcripts of the interviews were limited to access by the researcher and team members involved in the research process. The qualitative analysis of the interview transcripts was conducted using thematic analysis, which is a flexible methodology suitable for various epistemologies, approaches, and analysis methods (Braun & Clarke, 2022). The analysis was conducted with the help of a critical friend. Dr. Sarah Lawrason, a post-doctoral fellow with extensive experience in qualitative research, played a pivotal role in the 24 analysis process. Her expertise and background made her an ideal candidate to provide valuable insights and guidance throughout the qualitative analysis. During the theme development stage, Dr. Lawrason cross-checked the coded data to verify the accuracy and alignment of the themes with the participants' responses. Through inductive analysis, we employed the six steps of thematic analysis to identify broader themes in the interview transcripts. In the initial step, we thoroughly read the interview data to gain familiarity with its content. Subsequently, in the second step, we generated codes and systematically applied them to the data, identifying noteworthy features, patterns, and meaningful segments. These codes served as labels or tags assigned to specific data sections, capturing the essence of the content. In the third step, we engaged in an in-depth search for broader patterns and connections between codes, thereby unveiling potential themes. Themes, as patterns of meaning that emerged from the data, were the focal point of our analysis. Moving forward to the fourth step, we reviewed and refined the themes by organizing related codes under each theme, ensuring coherence and comprehensiveness. This iterative process allowed us to strengthen the validity and reliability of the identified themes. In the fifth step, we defined and named the themes, creating clear and concise representations based on the data. Ensuring each theme accurately reflected the coded data, we emphasized meaningful interpretations to facilitate understanding. Finally, in the last step, we presented our findings in a comprehensive report. This report contained the identified themes, along with supporting quotes to provide evidence for each theme's existence. Through this report, we constructed a coherent narrative of the themes, contextualizing their implications within the framework of the research question. This methodical and rigorous approach to thematic analysis allowed us to draw meaningful insights from the qualitative data, enriching our understanding of the interview participants' experiences and perspectives. 25 2.7.2.3 Deductive analysis For the deductive analysis, our focus was on identifying evidence related to the six aspects of quality participation: autonomy, belongingness, challenge, engagement, mastery, and meaning. Systematically examining the interview transcripts, we diligently coded statements that demonstrated these aspects. Each statement was categorized under the respective dimension, such as autonomy, belongingness, challenge, engagement, mastery, or meaning. By grouping the statements into these meaningful categories, we aimed to capture the participants' experiences and perspectives regarding the different dimensions of quality participation. This method allowed us to discern patterns and insights related to autonomy, belongingness, challenge, engagement, mastery, and meaning in the context of the research objectives. Employing this deductive approach, we were able to extract valuable data and provide a comprehensive analysis of the participants' perceptions and experiences in relation to the six aspects of quality participation. 2.8 Data storage The study data, including survey responses and PA estimates from the accelerometer, were organized and stored using a secure data management tool called REDCap (Research Electronic Data Capture; v11.0.3, Nashville, USA). REDCap is a web-based application specifically designed for data collection and management in research studies. It is widely used in academic and research institutions. REDCap provides a secure and user-friendly platform for researchers to create electronic forms for data collection. The forms can be customized to capture the specific variables and data needed for the study, such as survey responses and accelerometer data. Participants can enter their responses directly into the REDCap system, ensuring accurate and efficient data collection. After the completion of data collection and organizing the dataset, the 26 data from the study, including survey responses, PA estimates from accelerometers, and interview data, were exported from the secure data management tool REDCap for analysis. To ensure long-term storage and data security, the dataset, accelerometer data, and interview data were stored in the access restricted UBC TeamShare Drive. The UBC TeamShare Drive is a secure file storage system provided by the University of British Columbia (UBC) that allows researchers to store and share data within a controlled environment. By restricting access to authorized personnel, the research team aimed to protect the integrity and confidentiality of the data while complying with ethical guidelines and regulations for data management and privacy. 27 Chapter 3: Results 3.1 Participants’ characteristics This study focused on investigating the PA and P.E. levels and experiences of children with physical and/or sensory disabilities in British Columbia. Disabilities encompass a range of conditions affecting physical functioning, sensory perception, or both. Physical disabilities affect mobility, coordination, or strength, such as cerebral palsy or limb differences, while sensory disabilities impact vision, hearing, or tactile perception, such as visual impairment or hearing loss. By including both physical and sensory disabilities, this study aimed to understand the experiences and challenges faced by children with diverse disabilities in relation to PA and P.E. Individual participant characteristics are shown in Table 1. Table 1 Demographic characteristics Among the total sample of 11 participants, as shown in Table 2, 45% (n=5) had sensory disabilities, and 55% (n=6) had physical disabilities. Seventy percent of participants with sensory disabilities were girls (n=3) and 30% were boys (n=2). Within the subgroup of participants with physical disabilities, 83% were boys (n=5), and 17% were girls (n=1). The mean age of the participants was 10.18 (SD±2.27) years. Participant Gender Age (years) Type P1 Girl 12 Sensory P2 Girl 9 Sensory P3 Boy 11 Physical P4 Boy 12 Physical P5 Girl 8 Physical P6 Boy 10 Sensory P7 Boy 8 Sensory P8 Boy 11 Physical P9 Girl 8 Sensory P10 Boy 8 Physical P11 Boy 15 Physical 28 Table 2 Demographic information of the study sample Total Sensory Physical Gender n (%) Girl Boy 11 (100%) 4 (40%) 7 (60%) (45%) 3 2 (55%) 1 5 Age (years) 10.18±2.27 9.40±1.60 10.60±2.80 Height (cm) 138.80±24.00 136.90±31.60 140.70±18.00 Weight (kg) 38.2±13.40 38.80±14.90 37.70±13.40 Note: Results reported as n (%) or mean (M) ± standard deviation (SD) Figure 1 provides information on the geographical distribution of study participants. Among 11 participants, 9 resided in the Lower Mainland and 2 in the Central Okanagan area. Figure 1 Geographical distribution of study participants Note: Mainland/Southwest corresponds to Lower Mainland and Thompson-Okanagan corresponds to Central Okanagan area 3.2 Daily moderate-to-vigorous physical activity (Daily MVPA) One of the aims of this study was to examine the PA levels of participants with sensory and/or physical disabilities in relation to the daily PA target as recommended in The Canadian 24-Hour Movement Guidelines for Children and Youth. In general, the guidelines provide recommendations for individuals of all abilities to engage in PA throughout the day. According to 29 these guidelines, children and youth (ages 5-17) are advised to accumulate at least 60 minutes of MVPA daily. Figure 2 displays individual data derived from MVPA during P.E. classes, school-based MVPA, and MVPA throughout the remaining portions of the day. It illustrates the varying levels of MVPA observed among individuals with sensory and physical disabilities. Notably, the data reveal that merely two participants (20%) adhered to the 24-Hour Canadian Physical Activity Guidelines. 020406080 P1 P2 P3 P5 P6 P7 P8 P9 P10 P11Avregae Daily MVPA(min/day)Other MVPASchool MVPAP.E. MVPA Figure 2 Individual mean daily MVPA Data is available for 10/11 participants. P7 and P11 did not have any P.E. classes during the measurement period. P4 was not included in the analysis, due to missing accelerometer data. Notes: Other MVPA was calculated by subtracting School MVPA and P.E. MVPA from MVPA outside of the school time. MVPA – Moderate-to-Vigorous Physical Activity P.E. – Physical Education Red line represents the Goal MVPA as per The Canadian 24-hour Movement Guidelines for Children and Youth As shown in Table 3, among 11 participants, accelerometry data was successfully recorded for 10 of them. On average, the participants wore the accelerometers for 779.90 (SD±39.20) minutes per day. The number of valid days (≥ 600 mins per day of wear time) recorded varied among the participants. Five participants had a complete set of 7 valid days, while three participants had 6 valid days. Two participants had 5 and 4 valid days, respectively. The mean daily MVPA among the 10 participants was 35.62 (SD±21.40) minutes per day. MVPA Goal 30 Table 3 Individual and group mean Daily MVPA PARTICIPANT WEAR TIME (MIN/DAY) VALID DAYS DAILY MVPA (MIN/DAY) P1 757.20 7 31.55 P2 811.89 7 36.85 P3 797.93 6 40.28 P4 N/A N/A N/A P5 712.75 4 0.75 P6 775.05 5 39.96 P7 777.50 7 73.35 P8 848.81 6 14.37 P9 772.39 7 57.21 P10 737.37 6 2.00 P11 808.46 7 62.75 MEAN 779.90 6.20 35.62 SD 39.20 1.00 21.40 MVPA – Moderate-to-Vigorous Physical Activity 3.3 School moderate-to-vigorous physical activity (School MVPA) Table 4 shows MVPA during school time. The analysis was conducted based on valid school days, which varied among the participants. Specifically, two participants had three valid school days, three participants had four valid school days, and five participants had five valid school days within the 7-day data collection period. On average, time spent in MVPA during school was 21.28 (SD±17.15) minutes per day. These findings shed light on the level of PA engagement during instructional and non-instructional periods within the school day. 31 Table 4 Individual and group mean school MVPA PARTICIPANT SCHOOL TIME (MIN/DAY) VALID SCHOOL DAYS SCHOOL MVPA (MIN/DAY) P1 376 5 19.35 P2 360 5 15.85 P3 355 4 14.25 P4 N/A N/A N/A P5 343 4 0.25 P6 400 5 37.65 P7 355 5 33.70 P8 384 4 1.87 P9 395 5 37.3 P10 405 3 0.68 P11 310 3 51.91 MEAN 367.40 4.30 21.28 SD 29.37 0.80 17.15 MVPA – Moderate-to-Vigorous Physical Activity Figure 3 below demonstrates that four out of the ten participants met or exceeded the recommended threshold, as outlined by the Ministry of Education in British Columbia for Daily Physical Activity (DPA) within the school policy (Daily Physical Activity Kindergarten to Grade 12 Program Guide (Updated 2011) Ministry of Education). 0204060 P1 P2 P3 P5 P6 P7 P8 P9 P10 P11Average School MVPA(min/day)School MVPA Figure 3 Individual mean school-based MVPA Data is available for 10/11 participants. P4 was not included in the analysis, due to missing accelerometer data. MVPA – Moderate-to-vigorous physical activity Red line represents the Daily MVPA goal as per The Ministry of Education BC, DPA school policy. MVPA Goal 32 3.4 Physical education based moderate-to-vigorous physical activity (P.E. MVPA) As per results in the Table 5, it was found that during the week of data collection, 6 participants had one P.E. class, while 2 participants had two P.E. classes. Notably, 2 participants did not have any P.E. classes during that week. The study's findings revealed that, on average, participants engaged in 5.45 minutes of MVPA during a typical 48-minute P.E. class, with a standard deviation of 5.83 minutes. The average duration of the P.E. class was 48 minutes, with a standard deviation of 13.11 minutes. These findings provide insights into the level of MVPA achieved during P.E. classes within the context of the PHE curriculum. Table 5 Individual and group mean P.E. based MVPA PARTICIPANT P.E. DURATION (MIN/DAY) P.E. SCHEDULE (TIMES/WEEK) P.E. MVPA (MIN/DAY) P1 40 1 10.50 P2 60 1 0.75 P3 35 1 6.50 P4 N/A N/A N/A P5 30 1 0 P6 69 2 10.25 P7 N/A 0 N/A P8 45 1 0.62 P9 55 2 14.75 P10 50 1 0.25 P11 N/A 0 N/A MEAN 48 1 5.45 SD 13.11 0.66 5.83 MVPA – Moderate-to-Vigorous Physical Activity P.E. – Physical Education 3.5 Total Daily Physical Activity The concept of Total Daily Physical Activity encompasses the comprehensive accumulation of physical activity undertaken by an individual within a 24-hour timeframe. For the purpose of this study the duration of LPA and MVPA was aggregated across various contexts, including school non-instructional time, P.E. classes, and the remaining portions of the day. 33 The Table 6 provides insights into the average minutes spent in different intensities of PA throughout the day. On average, children spent 220.07 (SD±67.64) minutes per day in LPA. In terms of MVPA, children spent an average of 35.62 (SD±21.40) minutes per day. Moreover, when considering total PA accumulated throughout the day, which includes school non-instructional time and P.E. time, children spent an average of 255.97 (SD±80.02) minutes per day in total PA. Table 6 Individual and group mean Daily PA PARTICIPANT DAILY LPA (MIN/DAY) DAILY MVPA (MIN/DAY) TOTAL PA (MIN/DAY) P1 202.10 31.55 233.65 P2 302.04 36.85 338.89 P3 238 40.28 278.28 P4 N/A N/A N/A P5 145.5 0.75 146.25 P6 310.42 39.96 350.38 P7 246.70 73.35 320.05 P8 200.06 14.37 214.43 P9 276.89 57.21 334.10 P10 102.26 2 104.26 P11 176.75 62.75 239.50 MEAN 220.07 34.48 255.97 SD 67.64 23.33 80.02 PA – Physical Activity LPA – Light Physical Activity MVPA – Moderate-to-Vigorous Physical Activity Figure 4 provides an overview of the average duration of PA specifically during school time, P.E. time, and PA for the rest of the day for each participant. Average time spent in total PA during school time was 137.54 (SD±50.40) minutes per day. This indicates a considerable amount of time dedicated to PA within the school setting. Moreover, focusing specifically on P.E. classes, participants engaged in an average of 27.14 (SD±12.81) minutes per day of total PA intensity. 34 0100200300400Average Total Physical Activity (min/day)Other PASchool PAP.E. PA P1 P2 P3 P5 P6 P7 P8 P9 P10 P11 Figure 4 Individual level Total Physical Activity Data is available for 10/11 participants. P4 was not included in the analysis, due the missing accelerometer data. P7 and P11 did not have P.E. class during the 7-day measurement period. Notes: Total Physical Activity (LPA+MVPA). Other was calculated by subtracting School PA (LPA+MVPA) and P.E. PA (LPA+ MVPA) from Daily PA (LPA+MVPA). PA – Physical Activity LPA – Light Physical Activity MVPA – Moderate-to-Vigorous Physical Activity P.E. – Physical Education 3.6 Comparison of PA between sensory and physical disability groups Table 7 shows that after adjustment for gender and age, the total DPA was significantly higher in the sensory disability group (331 minutes/day, 95% CI: 261-402) compared to the physical disability group (152 minutes/day, 95% CI: 81.7-222) (t(6) = -4.198, p = .005698). Similarly, the sensory disability group also engaged in significantly more minutes of MVPA per day (50.11 minutes/day, 95% CI: 26.1-74.1) compared to the physical disability group (8.93 minutes/day, 95% CI: -15.1-33) (t(6) = -2.825, p = .0301). Furthermore, when examining daily PA levels during school time, the sensory disability group had significantly higher PA (243 minutes/day, 95% CI: 199.9-286) compared to the physical disability group (103 minutes/day, 95% CI: 60.3-147) (t(6) = -5.333, p = .00177). However, no significant differences were found in 35 MVPA during school time between the two groups, even though the MVPA much lower in the physical disability group. Regarding PA specifically related to P.E. classes, the sensory disability group also had a longer duration of P.E. classes (57.4 min/day 95% CI: 49.3-65.6) compared to the physical disability group (35.7 min/day, 95% CI: 27.8-43.5) (t(4) = -5.036, p = .007303). As can be seen in the table 6 above the sensory disability group had significantly higher levels of P.E. based PA (40.8 min/day, 95% CI: 30.74-50.9) compared to the physical disability group (15.5 min/day, 95% CI: 5.82-25.2) (t(4) = -4.759, p = .00891). No significant differences were found in MVPA during P.E. classes between the two groups, although the MVPA was much lower in the physical disability group. Table 7 Comparison of PA between sensory and physical disability groups Disability Sensory (n=5) Physical (n=5) p-value Daily PA Wear Time (min/day) 794 (749-839) 769 (723-814) .385 MVPA (min/day) 50.11 (26.10-74.10) 8.93 (-15.10-33) .0301* Total PA (min/day) 331 (261-402) 152 (81.7-222) .005698* School time PA (min/day) School duration 371 (332-409) 358 (319-397) .604 MVPA (min/day) 32.26 (10.60-53.90) 9.18 (-12.50-30.80) .1297 Total PA (min/day) 243 (199.9-286) 103 (60.30-147) .00177* P.E. based PA (min/day) P.E. duration 57.40 (49.30-65.60) 35.70 (27.80-43.5) .007303* MVPA (min/day) 10.100 (1.65-18.55) 1.44 (-6.67-9.56) .1246 Total PA (min/day) 40.8 (30.74-50.90) 15.5 (5.82-25.20) .00891* *Denotes a significant between-group difference at a two-sided alpha of .05. Data is available for 10/11 participants. Notes: Total Physical Activity (LPA+MVPA). Values given are estimated marginal means (95% CI) after adjusting for gender and stratified age unless otherwise stated. Age stratified – participants were divided in the two age groups, 8 to 10 years old, and 11 to 15 years old. PA – Physical Activity Daily PA – Daily Physical Activity MVPA – Moderate-to-Vigorous Physical Activity P.E. – Physical Education In summary, the results revealed that only two participants achieved average daily recommendation of 60 minutes of MVPA. Regarding DPA policy, 4 out of 10 participants 36 accumulated 30 minutes of school MVPA. Furthermore, individuals with sensory disabilities exhibited higher levels of daily total DPA, and MVPA compared to those with physical disabilities. They also engaged in higher levels of PA during school time and P.E. classes. It is important to note that individual variations existed within each disability group. 3.7 Qualitative results This study aimed to gain insights into the experiences of children with disabilities in P.E. classes, contributing to a deeper understanding of their participation. By uncovering the quality of their experiences, this research can inform improvements and strategies to promote inclusive and meaningful P.E. opportunities for children with disabilities in British Columbia. The study's findings provide valuable insights for policy makers, educators, and researchers, facilitating the development of inclusive strategies to enhance PA opportunities and experiences for children with disabilities. Through inductive thematic analysis, we were able to identify several recurring themes that emerge from the experiences and narratives of individuals. These themes provide valuable insights into the underlying patterns, meanings, and perspectives within a particular context. In the context of PA participation, deductive analysis has revealed rich and multifaceted aspects of quality participation that shed light on the diverse experiences, motivations, and impacts of engaging in PA during P.E. classes. The results form inductive thematic analysis are presented first. The findings provide a compilation of responses obtained from both children and parents. By incorporating the subjective perception, lived experiences of and perspective of parents, the themes gave a valuable insight concerning children’s participation in PA during P.E. classes. 37 3.7.1.1 Importance of the staff Staff support is essential for promoting the active and meaningful participation of children with sensory and physical disabilities in PA. Support from staff enhances accessibility, provides individualized assistance, and fosters a sense of belonging and social interaction. By recognizing the unique needs and abilities of each child and providing tailored support, staff members can empower children with disabilities to engage in PA, experience personal growth, and enjoy the numerous physical, social, and psychological benefits associated with active participation. Nick's parent (sensory disability) shared how important is their resource teacher that works within the school: "He has a great resource teacher. She went in and spoke to the P.E. teacher and gave suggestions of the different types of games that they can play. For badminton, you can get oversized birdies and oversized rackets, so it is easier for Nick to hit. She actually brought them in for the school so they could use it in the class." This support illustrates the importance of understanding the individual needs of children with disabilities and providing personalized support. By recognizing and addressing the limitations they face, staff members can create a more inclusive and meaningful environment. This not only enhances the child's overall experience, but also fosters a sense of belonging, empowerment, and personal growth. Callie's parent (physical disability) emphasized how the involvement of supportive individuals, such as teachers or educational assistants, who provide guidance and extra attention to specific tasks, can significantly enhance a child's success in physical activities: P.E. teacher knows what Callie can do and what she cannot do. She is also in contact with class teacher and school physio. They are all out of the box thinkers. They really look at how to adapt sports to keep Callie engaged. 38 The staff, including the P.E. teacher, class teacher, and school physio, demonstrate an understanding of Callie's unique abilities, challenges, and needs. They go beyond to proactively seek ways to modify sports and activities, making them accessible and engaging for Callie. This collaborative effort ensures consistency, enhances the quality of support, and maximizes Callie's overall experience. Altogether, the shift towards providing valuable and fulfilling experiences for children with disabilities in physical activity participation through staff support contributes to their holistic development, fosters positive school experiences, and encourages personal growth. By recognizing individual needs and tailoring approaches, the staff helps children navigate social challenges while still finding meaning and fulfillment, ultimately promoting their overall well-being and success. 3.7.1.2 Importance of task Tasks facilitate skill development and individualization, allowing children to enhance their physical abilities and track their progress. Tasks provide appropriate levels of challenge, promoting engagement, motivation, and a sense of accomplishment. By prioritizing task selection that considers the individual needs of children with sensory and physical disabilities, we can create a supportive and inclusive environment that empowers them to fully participate and enjoy the benefits of PA. Maria (sensory disability) said: "Well, I don’t like badminton. I find it quite hard to hit the birdie across and very high over the net. But I always try." In this quote, Maria's willingness to try and participate in the task reflects the importance of the task in PA participation. The focus is not on comparing their abilities to others but on their individual effort and progress. Through the tasks provided, she had the opportunity to explore her potential, build skills, and experience a sense of accomplishment. This approach promotes a positive mindset, self-belief, and overall well-being, ensuring that PA participation becomes a meaningful and enriching experience for children with disabilities. 39 On the other hand, when children with disabilities are consistently faced with tasks that they cannot physically perform, they may experience stigmatization, negative self-perception, or a fear of being judged by their peers. Furthermore, children may develop a fear of being judged by their peers when they are unable to keep up with certain tasks. They may worry about being seen as "weak" or "inferior", which can lead to a reluctance to participate. This fear of judgment can have long-lasting effects on their social interactions and overall engagement in PA. Ryan's parent (physical disability) shared: "They would do sprints where they would have to run back and forth for 10 min, non-stop. And he just could not physically do any of that, so he spent a lot of time having behaviors and trying to get removed from class so that the other kids do not see that he could not keep up. He would rather get kicked out or pretend to be hurt." Ryan's negative experience in PA can have profound effects on his motivation, enjoyment, and willingness to participate. When faced with tasks that are too challenging or that highlight his limitations, he may feel discouraged and disengaged. This can lead to a decrease in his overall enjoyment of physical activities and a reluctance to participate in them. Ryan may develop a dislike for PA because of the negative emotions and experiences associated with them. Moreover, he may actively avoid participating to prevent potential embarrassment or negative social encounters. This avoidance behavior can further perpetuate his disinterest in PA and limit his opportunities for physical and social development. By offering a range of tasks that cater to individuals' preferences and abilities, PA programs can create a positive and meaningful experience for participants, fostering a lifelong commitment to health. Tasks that align with children's skills and preferences, PA participation could become more meaningful and enjoyable, and ultimately contribute to their overall well-being. 40 3.7.1.3 Teaching self-advocacy Teaching advocacy in PA participation for children with disabilities promotes empowerment, self-expression, active participation. Moreover, teaching advocacy is empowering them to have a voice, provide feedback, and contribute meaningfully to their own experiences. The quote from Callie's parent exemplifies the importance of teaching advocacy "They really do see her as someone who can give feedback, thoughtful feedback. She will try something, and she gives really good constructive feedback, and they seem to really enjoy that." This empowers Callie to actively engage in decision-making processes related to her participation in PA, ensuring her voice is heard and her unique needs are addressed. Maria (sensory disability) is encouraged by her parent to self-advocate when needed. The thing we are trying to teach her is that even if your teacher may not notice, it is up to you to speak up and make sure that you are taken care of. I know that the teacher may have 24 other students. And there may be other issues that she needs to take care of. But at the same time, Maria needs to learn how to protect herself. If there is anything, she needs to talk to an adult, or her friends can help. By doing so, Maria learns to recognize the importance of her own well-being and the significance of seeking assistance when needed. Encouraging her to approach an adult, such as her teacher or another trusted staff member, allows her to voice her concerns and seek guidance or accommodations. Additionally, emphasizing the role of friends as potential sources of support teaches her the value of seeking assistance from peers. 3.7.1.4 Need to look outside of the school Parents and caregivers play a significant role in advocating for their child's right to participate in PA. They may seek external resources, such as community-based programs, 41 clubs, or organizations that offer inclusive activities specifically designed for children with disabilities. When children with disabilities do not have sufficient PA opportunities at school, or when parents are concerned about their child's limited participation due to their disability, it becomes crucial to explore alternative avenues for engaging in PA. One example of looking for activities outside of the school is Nick (sensory disability) and his parent’s concern for Nick's overall participation in P.E. in school: Right now, we are trying to find resources that we can put him into or places we can put him into where there is going to be kids that are at the same level and ability as him. So, he does not feel left out. Finding appropriate external activities involves exploring community-based programs, specialized clubs, recreational centers, or support groups that cater to children with similar disabilities or skill levels. These activities could provide an opportunity for every child to interact with peers who can relate to their experiences, challenges, and achievements. In this case, Nick could be surrounded by others who share similar abilities and limitations and could alleviate feelings of being left out or different, allowing him to feel accepted and understood. When looking for activities outside of the school for Ryan (physical disability), his parent said it is important to consider his passion and interests: If Ryan has a passion and he is able to keep doing that sport, we will let him keep doing it as long as it is safe. We do not fully know the extent of his medical condition, and whether it is degenerative or not. The longer that he can stay physically active, the better it is going to be for his body. While it is essential to ensure that Ryan's participation in the chosen activity is safe, taking into account any potential risks or limitations associated with his disability, the focus should be on finding ways to adapt and modify the activity to meet his needs. This may involve 42 working closely with coaches, trainers, and healthcare professionals to develop strategies and accommodations that allow Ryan to participate safely while still enjoying the sport. 3.7.2 Quality Participation The analysis of quality participation employed children's responses concerning their experiences in P.E. classes, focusing on identifying quotes that align with the six themes of quality participation: autonomy, belongingness, challenge, engagement, mastery, and meaning. The results offer an informative overview and detailed description of these themes, supported by relevant quotes that capture both positive and negative aspects of themes. The theme of autonomy encompasses children's feelings of choice, control, and self-direction in P.E. classes. Belongingness relates to the sense of connection, acceptance, and inclusion experienced by children within the class. The challenge theme reflects the perception of appropriate difficulty levels and opportunities for growth and skill development. Engagement refers to the level of interest, involvement, and active participation demonstrated by children during P.E. classes. Mastery pertains to the sense of accomplishment, progress, and competence experienced by children. Lastly, the theme of meaning explores the extent to which children perceive value, relevance, and enjoyment in their P.E. experiences. Findings presented below give a valuable understanding of the multifaceted nature of quality participation in P.E. classes for children with physical and/or sensory disabilities. 3.7.2.1 Autonomy The element of ‘autonomy’ for quality participation in physical activity among children with disabilities refers to providing children with disabilities the opportunity to actively engage in physical activities of their choice while maintaining control over their own participation. 43 Positive Autonomy involves empowering children with disabilities to make decisions, set goals, and take ownership of their physical activity experiences. For example, when asked about doing PA in school, Callie (physical disability) said: In school, they ask me: This is the activity, how can we make this work for you? Or ask me what you do, so we can make it work? A lot of it is in my decision. They asked me what I can do and I can decide. Callie demonstrates that she experiences autonomy as school leaders ask what she wants to do before the activity begins. Therefore, Callie is involved in the decision-making process of how she wants to engage in PA. To experience autonomy, teachers need to thoughtfully plan with students with disabilities before the activity begins. Negative One of the downsides of certain PA settings is the limited freedom to choose what activities to participate in and how to engage in them. This lack of autonomy can be restrictive and diminish the overall experience: "In gym class, some things I try to do on my bike because it’s walking. If it is running, then the teacher says just try your best. Like I can’t run with them, I’m much slower than anyone else." (Callie, physical disability) Limited autonomy in PA participation arises when individuals are not given the opportunity to choose their preferred activities or determine how they want to engage in them. The common instruction to do your best may appear inclusive on the surface, but it often fails to consider the unique needs, wants, abilities, and contextual factors of individuals. As a result, their genuine participation in quality physical activity may not be adequately supported. However, while this adjustment acknowledges the need for accommodation, it still falls short of granting individuals the full autonomy to determine their own preferred modes of engagement. 44 Overall, when children are provided with the opportunity to shape the game and PA based on their own abilities, they experience a sense of autonomy. This means that they feel empowered and in control of their participation, which has positive effects on their overall engagement and enjoyment. By giving children a choice in how they participate, such as allowing them to select game variations or adapting rules, they become active contributors to the activity rather than passive participants. 3.7.2.2 Belongingness Belongingness, in terms of quality participation in PA, refers to the sense of inclusion, acceptance, and connectedness that children experience within the activity setting. It is about creating an environment where children with disabilities feel valued, supported, and a part of the group, enabling them to fully engage in PA alongside their peers. Positive For sense of belonging in P.E. activities, Meghan (sensory disability) said: “Sometimes I participate in P.E. just because I want to be part of the game.” The quote reflects that belongingness is a fundamental aspect of quality participation in PA. It demonstrates that children are not solely motivated by the game itself but by their innate need to belong and connect with others. This sense of belonging contributes to their overall positive experiences, motivation, and engagement in PA. Negative Conversely, negative experiences of belonging refer to situations in which children with physical and sensory disabilities feel excluded, isolated, or disconnected from their peers or the broader social environment during their participation in PA. As demonstrated by the quote from Callie (physical disability): "They kind of motivate you to do it, but then it's hard for me when they don’t understand that sometimes I don’t want to play, and I get really tired". This quote demonstrates the element of negative belongingness as she did not feel understood or 45 acknowledged in her preferences, limitations, or needs related to participation. It reflects the negative impact that a lack of empathy or recognition can have on her sense of belonging and well-being. Overall, children experience positive belonging when they feel accepted, included, and connected within a group or community engaged in PA. Positive belongingness occurs when children's preferences, needs, and boundaries are respected and understood. Nevertheless, children experience negative belonging when they feel a lack of acceptance, understanding, or support within the group. 3.7.2.3 Challenge Challenge plays a crucial role in fostering the development of physical, cognitive, and social skills for children with disabilities. It involves striking a balance between providing activities that are within their capabilities and offering opportunities that encourage them to stretch their limits and strive for improvement. It is important to note that challenges should be individualized and tailored to each child's unique abilities and needs. They should be achievable yet require effort and encourage growth without causing undue frustration or discouragement. Positive Sara (sensory disability) experienced the positive side of being challenged as quality participation: I am pretty sure I can do most of the things we are doing in P.E. Sometimes when we are practicing badminton and the footwork, our teacher helps the kids who are not really doing so good with it. The quote shows that Sara experienced a sense of capability and support when facing challenges. She felt confident in their abilities and appreciated the guidance and assistance provided by their teacher in improving their skills. This highlights the positive experiences of challenge, where children perceive obstacles as opportunities for growth, and receive appropriate support to overcome them. Furthermore, this quote aligns with the definition of 46 challenge as it portrays a similar situation where a child perceives the teacher's assistance as a valuable resource in overcoming challenges and improving their performance. Negative One notable finding was that some children also expressed frustration and disappointment when they were unable to participate due to difficulties in learning the rules or performing certain activities. Jordan (physical disability) shared “I used to get upset in P.E class, because I could not do anything, I was not able to learn the rules of anything, and I had to just sit on the bench for the rest of P.E.”. This highlights the negative experiences of challenge, where children perceive barriers and limitations that hinder their active engagement in P.E. activities. The negative experiences of challenge are significant as they highlight the barriers and limitations that children with physical and sensory disabilities may face in P.E. settings. It emphasizes the need to address these challenges and create inclusive environments that provide appropriate accommodations, adaptations, and support. In summary, challenge, in the context of quality participation, refers to the difficulties and obstacles that children encounter while participating in PA. It encompasses both physical and cognitive challenges that may arise due to their disabilities or limitations. By providing appropriate challenges, personalized support, and opportunities for skills development, educators and caregivers can enhance the quality of participation, promote self-confidence, and empower children with disabilities to overcome obstacles and achieve their full potential. 3.7.2.4 Engagement In terms of quality participation in PA for children with physical and sensory disabilities, engagement refers to the active involvement, enthusiasm, and sustained interest that these children exhibit during their participation in PA. It encompasses their mental, emotional, and physical investment in the activity, resulting in a positive and meaningful experience. 47 Positive The positive experiences of engagement contribute to the holistic development and well-being of children. When children are actively engaged, they experience a range of benefits, including enhanced physical fitness, skill development, social connection, and a sense of accomplishment. The following quote from Jordan (physical disability) aligns with the definition of engagement as the participant actively participates in an activity and finds joy and fulfilment in the process of interacting and collaborating with others: Last unit, we were assigned to help our little buddies, kindergarten to grade 1. We had to create a poster for fitness station that demonstrates the exercise and we had to do the activity with them. I enjoy doing it, and also the little kids thought it was fun. In the context of helping younger children, engagement fosters leadership skills, empathy, and positive relationships. When children actively participate and engage with their peers, they have opportunities to take on leadership roles and responsibilities. Engagement in shared activities and interactions provides a platform for children to form positive relationships with their peers. For the children in this study, engagement in PA plays a crucial role in fostering a positive and meaningful experience. When children are actively engaged, they are fully involved and invested in the activity, which leads to a range of benefits. Furthermore, when children actively participate and experience success or improvement in their physical abilities, they gain a sense of accomplishment and belief in their own capabilities. 3.7.2.5 Mastery Mastery refers to the development and refinement of skills, competencies, and abilities. It involves acquiring a high level of proficiency in specific PA or movements, which allows individuals to engage in those activities with confidence, precision, and efficiency. 48 Positive Mastery is achieved through continuous practice, learning, and improvement. Experience shared by Callie (physical disability): "When we do some activity in the gym, my teacher says you do this in your chair. And I am like, Okay, I can try!" Callie demonstrates a positive attitude towards mastery, as she is willing to try and engage in the activity despite potential limitations. Negative Negative experiences of mastery can occur when children face challenges or limitations in their pursuit of skill development. The experience shared by Ryan (physical disability): "I’m good at dribbling, but I need more time for shooting. And we only do basketball for three weeks and there is not enough time for me to practice." This highlights the child's frustration with the limited time allocated to practice shooting skills. It reflects a negative experience of mastery as the child perceives a lack of opportunity to improve a specific aspect of their basketball skills. Addressing negative experiences of mastery is important as they can affect a child's motivation, self-esteem, and overall engagement in PA. To promote positive mastery experiences, it is necessary to provide sufficient practice time, individualized instruction, constructive feedback, and a supportive learning environment. By addressing the challenges and providing opportunities for skill development, children can experience a sense of mastery, competence, and personal growth in their PA participation. 3.7.2.6 Meaning Meaning refers to the significance, value, and purpose that children derive from their participation in PA. It encompasses meaningful experiences, personal growth, and positive outcomes that children with disabilities can attain through their engagement in physical activity. Meaningful participation in PA for children with physical and sensory disabilities is fostered by creating inclusive and accessible environments, providing appropriate adaptations and 49 accommodations, and promoting positive attitudes and support from peers, instructors, and caregivers. By recognizing and nurturing the meaning of participation, we can ensure that children with disabilities experience the full benefits and enjoyment PA, leading to lifelong engagement and well-being. Positive The positive side of the meaning in quality participation refers to the beneficial and fulfilling experiences individuals derive from engaging in PA. It involves personal fulfillment, where individuals find satisfaction and purpose in engaging in activities that align with their interests and goals. The positive meaning of Ryan’s (physical disability) participation in P.E. is shown in the quote: "When I feel I am not on the same skills level as my friends, I just keep pushing myself because I want to stay active and be with my friends" lies in his determination, resilience, and strong social connection. Ryan demonstrates his willingness to overcome challenges and the importance he places on the benefits of PA. Despite perceiving a difference in skill level compared to their friends, Ryan maintains a strong desire to stay active and be part of the group. Another positive example of meaning is reflected in this quote from Andrew (sensory disability): "I just listen to the teacher. It does not matter if I do not like the game. I am part of the team, and I will play like everyone else, I will do what I need to do, because it is a game." The statement reflects a positive meaning in the context of quality participation, where the value of teamwork and social inclusion takes precedence over personal preferences. In this case, Andrew expresses a strong sense of commitment and dedication to the team, highlighting their willingness to participate and contribute to the game, even if he does not personally enjoy it. This highlights the positive experiences of meaning, where children find personal significance, connection, and fulfillment in their participation beyond their individual preferences. Taken together, children feel the meaning as quality participation in PA, as it goes beyond mere engagement and taps into their personal fulfillment and self-expression. It 50 becomes a platform for their skill development and personal growth, allowing them to discover their capabilities and unlock their potential. Additional quotes are provided in Table 8 and Table 9 below. Table 8 Quality participation positive elements Element Positive Quote Autonomy Being given a choice Sometimes teacher gives us a choice. You can choose a gym period and lead it. You can do it with parent. I was doing soccer. (Meghan, sensory disability) Belonging Importance of friends I have so many friends there, and it is fun! (Ryan, physical disability) Challenge Feel confident Sometimes it is hard, depends on what we are doing. But, all along – I can do everything. (Ryan, physical disability) Goal-setting The good thing is, my last P.E. teacher is still in school, so he knows what I can do. (Callie, physical disability) Engagement Knowledgeable for specific disability For the sports days in school, they adapted the stations for me. (Callie, physical disability) Mastery Building skills My teacher suggested I can sit and observe and when I feel comfortable, I can join. (Jordan, physical disability) 51 Table 9 Quality participation negative elements Element Negative Quote Autonomy Lack of independence Yes, because it is mostly stuff that only my wheelchair could do, playground is not adapted. So, if I go outside, I do not go on my bike (adapted bike), I am always in my wheelchair, so I cannot use the playground. (Callie, physical disability) Belonging Exclusion The sport we do is by class vote. And most of the kids, everyone except me chooses dodge ball. (Jordan, physical disability) Team activity I am not keen on socializing, but it depends, if my best friend picks me then I would go play with them. (Jordan, physical disability) Challenge Adequate activity I participate but depends on what we are doing. (Jordan, physical disability) Inappropriate task They are running from one side of the school and back and doing all other running, but I cannot usually do all of it. (Callie, physical disability) Engagement Self-reflection I am not aware of what others are doing. (Maria, sensory disability) Mastery Lack of success I'm not comfortable with games and rules. Not any specific games – I just have troubles with almost everything. (Jordan, physical disability) 52 Chapter 4: Discussion This study provides a comprehensive examination of accelerometer-assessed PA and quality participation among children with diverse disability types during school-based P.E. By employing mixed-methods, which included accelerometry and interviews, detailed and multifaceted data on the PA levels and experiences of children with physical and/or sensory disabilities within the context of school-based P.E. were collected. This study effectively addresses a significant gap in the existing literature, as previous research is nonexistent. Going beyond a mere analysis of PA levels, this investigation delved into participation patterns during both instructional and non-instructional school activities, as well as activities outside the school environment. This comprehensive approach allowed for a more profound understanding of the factors influencing their engagement in PA during and outside of P.E. classes. The inclusion of both sensory and physical disabilities in this study was a deliberate choice to identify potential common themes in participants' experiences, despite the inherent differences in their disabilities. Regardless of their specific disability type, these participants engaged in PA at various levels and across different types of activities, sharing a common thread of involvement in settings such as P.E. classes, non-instructional school activities, and activities outside of the school environment. This approach contributes to a more holistic understanding of the challenges and opportunities faced by children with disabilities in participating in P.E. and related activities in British Columbia. 4.1 Summary of the findings The study aimed to assess the PA levels and quality participation P.E. experiences among children with physical and/or sensory disabilities. Firstly, the study examined whether these children were meeting the 24-hour movement guidelines. The findings revealed that only 53 two participants achieved an average of 60 minutes or more of MVPA per day during the seven-day data collection period. Secondly, the study explored whether the children were meeting the British Columbia DPA recommendations within school settings. It was found that only four participants recorded more than 30 minutes of MVPA during school hours. Lastly, the study focused on PA during P.E. classes and the quality of children's participation. The results indicated that, on average, children engaged in 5.45 minutes of MVPA during P.E. classes and had both positive and negative elements of quality participation. 4.1.1 Daily MVPA Consistent with the previous research, the findings of this study reveal a concerning non-compliance with the 24-Hour Canadian Physical Activity Guidelines among the participants, as only two children met the recommended level of 60 minutes of MVPA per day. These findings are consistent with previous research conducted by Moore et al. (2021), which reported that only 5.3% of children with disabilities met the MVPA guidelines. It is noteworthy to mention that our findings differ significantly from those of another recent study by Arbour-Nicitopoulos et al. (2021) who found that children with physical and sensory disabilities engaged in an average of 77 (59) minutes of MVPA throughout the 24-hour period. However, it is important to note that the activity levels in the latter study were self-reported, making comparisons difficult. It is important to note that this study focused only on the physical activity part of the guidelines. The guidelines also emphasize the importance of sedentary behaviour. Future research should focus on including measures of sedentary behaviour as well. Future research should also focus on addressing the substantial gap between the recommended guidelines of 60 minutes of MVPA and the actual PA levels of children with physical and/or sensory disabilities. Inclusive PA programs designed specifically for children with physical and/or sensory disabilities could be effective interventions. Representative and adequately statistically powered population-level data for diverse impairment types are needed 54 within existing Canadian PA monitoring and surveillance systems (Martin Ginis et al., 2021). These systems must consider access and quality of the school, including P.E. and community settings, and the disability/inclusion training of professionals (e.g., teachers and sport coaches). Rather than exclusion from PA or P.E. participation, the goal should be inclusion for all children with disabilities in appropriate activities. 4.1.2 School MVPA Another notable finding of this study is the relatively low level of compliance with the DPA requirements outlined by the Ministry of Education in British Columbia among the study participants. Out of the 10 participants, only 4 met the DPA policy, which requires a minimum of 30 minutes of MVPA during school days. This finding suggests that there may be challenges in implementing and ensuring adherence to DPA policies for children with physical and/or sensory disabilities. Additionally, interviews conducted during this study highlighted the importance for parents that their children not only engage in PA within the school, but also actively participate in these activities. One interesting finding within the school PA that stands out from the results is the higher activity levels observed among individuals with sensory disabilities compared to those with physical disabilities. These differences could be attributed to several factors. Common physical barriers include playgrounds and ball fields that are inaccessible to youth who use wheelchairs (e.g. grass surfaces, climbing apparatus with no ramps) and common programmatic barriers include not having the necessary staffing or support to accommodate the child during the activity or not having knowledgeable staff who understand how to adapt the game or sport to meet the child’s needs (Schreiber et al., 2004). Another possible explanation is that sensory disabilities may not directly impact the ability to engage in PA to the same extent as physical 55 disabilities. Sensory disabilities, such as visual or hearing impairments, may not inherently limit movement or physical function, allowing individuals to participate in a wider range of activities. It is worth noting that no previous studies have examined the PA levels of children with physical and/or sensory disabilities within the context of DPA school policies in British Columbia. This research gap underscores the need for future investigations to explore the PA levels and experiences of children with disabilities within the framework of DPA policies in this specific region. 4.1.3 P.E. MVPA There is a lack of information regarding the adaptation of the P.E. curriculum to meet the specific needs of children with physical and/or sensory disabilities. While there is a wealth of literature on the barriers and facilitators of PA participation outside of school (J. Haegele et al., 2018), less is known about participation in P.E. specifically. Based on our findings, children with physical and/or sensory disabilities engaged in an average of 5.45 minutes of MVPA during a typical 48-minute P.E. class. It is important to note that this is a specific group of children in British Columbia and their level of PA during P.E. classes has not been extensively studied. There is a gap in the existing research when it comes to understanding the amount of PA this group of children participates in during P.E. classes in the British Columbia context. Research conducted by J. A. Haegele & Sutherland (2015) and Pan et al. (2005) and highlights that school-based P.E. classes are the most common environment for school-aged individuals with disabilities to learn about and engage in PA. The influence of different pedagogical approaches is highlighted by J. A. Haegele & Hodge (2016) who describe physical educators influenced by the medical model of disability as potentially lacking in flexibility and attributing non-participation to students’ personal characteristics. The lack of experienced staff in these roles hinders children’s ability to participate fully. It limits their access to appropriate 56 modifications, personalized instruction, and comprehensive support, resulting in reduced opportunities for PA in school settings. Additionally, understanding the facilitators and barriers that influence student participation in P.E. could be crucial, as emphasized by Lieberman et al. (2002), as these factors can significantly impact the quality and effectiveness of P.E. programs offered. Consistent with this recommendations, Block & Obrusnikova (2007) suggest that some students with disabilities may present more challenges to P.E. teachers than others, emphasizing the need for tailored approaches. This aligns with our findings from the interviews where participants emphasized the importance of staff support such as educational assistants, physiotherapists and occupational therapists. Their role in communicating with the P.E. teachers and providing the school with the adapted equipment made a positive impact on participation during the classes. Our finding also suggested that there is a need to educate P.E. teachers on how to adapt the activities and include children of all abilities. An important next step in the research process will be to explore the perspective of P.E. teachers. Recent research, such as that conducted by J. A. Haegele & Sutherland (2015), highlighted the importance of positive peer interactions in P.E. as reported by children with disabilities, shedding light on the significance of social dynamics within the P.E. environment. Columna et al. (2019) found that many parents expressed regularly struggling with fears of having their child left out, hurt, or singled out during participation. Aligned with previous research, findings from this study revealed the importance of teaching children to self-advocate, when participating in certain tasks. Perhaps this could help P.E. teachers in creating appropriate and adaptive activities and give children opportunities to be active and have positive experiences and participation. Interesting to mention is that two participants did not have the P.E. classes during the data collection week due to Christmas party rehearsals. This observation underscores the 57 potential for children to be excluded from regular P.E. classes and overall PA in order to accommodate other events or activities. It highlights the need to critically examine the frequency and prioritization of P.E. classes for all children, particularly when they are scheduled only once per week. There are similarities between the attitudes expressed by parents in this study and those described by Columna et al. (2019) where parents felt having opportunities to play sports or learn skills in P.E. classes would motivate their children to participate in regular PA outside of school. This prompts important discussions on the equitable allocation of resources and time to ensure consistent opportunities for P.E. and PA for all children. 4.2 Quality participation Through interviews, we gathered rich qualitative data that shed light on the experiences of children with physical and/or sensory disabilities in the context of participation during P.E. The six aspect of quality participation, autonomy, belongingness, challenge, engagement, mastery, and meaning were identified in the reported experiences, all of which align with the Quality Parasport Participation Framework (Evans et al., 2018). These themes encompassed a range of experiences and perspectives, highlighting the diverse nature of participation for children with physical and/or sensory disabilities. The quality of P.E. participation among children with physical and sensory disabilities showed variability, with not all aspects consistently exhibiting positive or negative elements. The study's key finding suggests that children with disabilities experienced both positive and negative elements of quality participation across various aspects, except for the aspect of 'meaning'. These finding differ from Arbour-Nicitopoulos, Bruno, et al. (2022) where children experienced all positive elements of quality participation. Although no previous research has specifically examined the quality of participation in P.E. classes among children with physical and/or sensory disabilities, this study identified certain similarities with recent studies that have explored related topics. Consistent with the study done by Lawrason & Martin Ginis (2022) there 58 is a pattern in people with physical disabilities experiencing both positive and negative sides of quality PA participation. These similarities might indicate some common experiences and needs among children with disabilities when engaging in PA. The aspect of 'meaning' stands out as unique, as it appears to be consistently positive without any negative element reported. This suggests that children with disabilities might have found purpose and significance in their P.E. participation, regardless of the challenges they may have encountered in other aspects. An intriguing finding of this study is that participants with less visible disabilities, such as developmental coordination disorder and muscular dystrophy, demonstrated a tendency to avoid participating in P.E. activities. The reluctance to engage in such activities due to concerns about others' perceptions and uncertainties about rules can lead to feelings of frustration and reduced confidence among these participants. This aligns with previous research by Grenier (2011) and Shields & Synnot (2016), which also identified negative experiences in P.E. individuals with milder degrees of disability and highlighted the influence of social factors on participation. Future research in the field of P.E. and disability should indeed focus on understanding how participants perceive and experience their engagement, with a particular emphasis on identifying ways to improve their participation and ensure appropriate challenges during physical activities. The finding regarding the feeling of autonomy in P.E. is significant, as it highlights the importance of allowing children to have a sense of control and choice over their participation. When children are given the opportunity to shape the game or activity according to their abilities and preferences, they experience a greater sense of empowerment and ownership in their engagement. Arbour-Nicitopoulos, Bruno, et al. (2022) reported that disability status was a significant predictor of autonomy, such that those athletes who did not identify as having a disability reported higher ratings of autonomy compared to those who identified with having a 59 disability. This aligns with previous research conducted by Grenier (2011), which emphasized the significance of viewing students with disabilities beyond a medical model. By moving beyond a medical profile and focusing on their unique abilities and strengths, teachers can gain valuable insights that lead to more positive and engaging experiences for the students. The correlation between autonomy in P.E. and positive experiences can be attributed to several factors. When children have the freedom to select game variations, adapt rules, or participate in activities that suit their individual needs, they become active contributors to the activity rather than passive participants. The sense of belongingness experienced by children with disabilities during P.E. is a critical element that significantly impacts their overall participation and enjoyment (Pesonen et al., 2015). On one hand, when these children feel accepted as part of a team or group, they tend to have positive experiences and enjoy being actively involved in the activities (Ma & Allan, 2018). Being acknowledged and included in activities that align with their preferences and abilities could enhances their sense of belongingness and fosters a positive sense of identity within the P.E. setting. However, it is also important to recognize that the absence of such acknowledgment and inclusion can lead to negative experiences and feelings of exclusion. When children with disabilities perceive that their preferences or disability-related needs are not considered, they may feel left out or disconnected from the group, which can diminish their sense of belongingness. These negative experiences can adversely affect their motivation to participate and potentially limit their engagement in PA. The comparison with the findings of Shields & Synnot (2016) highlights some common themes in the reasons for participating in P.E. among children with disabilities. Like the children in the mentioned study, participants in our research also expressed enjoyment and a sense of success or competence as motivators for participation. The desire to keep fit and engage in 60 activities with friends or make new friends were additional factors that appeared to contribute to positive experiences in P.E. 4.3 Strengths and limitations This study has several strengths and limitations that should be considered when interpreting the findings. One of the strengths of this study is that it focuses on children with physical and/or sensory disabilities, a diverse group that has received limited attention in previous research. By examining their participation in PA and P.E., this study fills an important gap in the literature and provides valuable insights into the experiences of these children. One of the notable strengths of this study is the utilization of a mixed methods design, incorporating both quantitative and qualitative approaches. This combination of methods allowed a more comprehensive and nuanced understanding of PA among children with physical and/or sensory disabilities. The quantitative component of the study, utilizing accelerometers, provided valuable quantitative data on the levels and patterns of PA among the participants. This quantitative component added rigor and objectivity to the study, strengthening the validity of the findings. Complementing the quantitative data, the qualitative component of the study that included interviews with participants, both parents and children, offered a deeper understanding of the experiences, perspectives, and contextual factors influencing PA among children. Through qualitative methods, we were able to explore the unique experiences related to PA participation and quality participation during P.E. classes. The virtual nature of this study is also a significant strength as it allowed individuals from diverse geographical locations across British Columbia to participate. The distribution of pre-paid packaged devices enabled remote data collection of PA through accelerometry. Additionally, online interviews facilitated the collection of qualitative data, providing participants with the opportunity to share their subjective perspectives on PA experiences without the need for in-person interactions. 61 However, it is important to acknowledge the limitations of this study. One potential limitation is the possibility of selection bias, as the participants in this study may have been more physically active or motivated to participate in PA compared to non-participants. This could have resulted in smaller differences in PA levels between children with sensory disabilities and those with physical disabilities. It is important to consider that the differences observed in this study may be larger or smaller when applied to the general population of children with disabilities. Another limitation is the categorization of individuals based on their reported disability. This approach may not fully capture the variability in PA behaviors within these groups. Different individuals within the same diagnostic category may have different activity levels and preferences. Future research should aim to include larger and more diverse populations, considering various disability types, to obtain a more comprehensive understanding of the differences in PA patterns among children with disabilities. Accelerometers provide valuable information about movement and intensity, but they have limitations in capturing specific activities. Activities like cycling or swimming, as well as movements like walking uphill or carrying a load, may not be captured effectively by accelerometers. This limitation is particularly relevant for individuals who rely on wheelchairs for mobility, as the intensity of their PA may be underestimated. Consequently, the engagement of wheelchair users in PA may not be fully represented by accelerometer data. Furthermore, while qualitative methods offer in-depth insights into the experiences and perspectives of individuals, it is important to recognize their subjectivity and potential biases. The findings obtained through qualitative analysis represent the experiences of the specific sample of participants involved in the study and may not be generalizable to the broader population of children with disabilities. Researchers should be mindful of the potential for participant bias, researcher bias, and social desirability bias when interpreting qualitative data. 62 Certainly, this study makes a valuable contribution to our understanding of P.E. PA participation among children with physical and/or sensory disabilities. By shedding light on their activity levels and participation experiences, this research may inform the development of interventions and strategies aimed at promoting PA and fostering inclusivity for all children, irrespective of their abilities. The insights gained from this study may guide the design and implementation of targeted interventions to address the specific barriers and challenges faced by children with disabilities in engaging in PA. For instance, findings related to the lack of experienced staff or the need for adapted equipment highlight areas where improvements can be made to support and enhance PA opportunities for these children. By tailoring interventions to address these specific needs, we can create more inclusive and supportive environments that facilitate greater participation and enjoyment of PA. 63 Chapter 5: Conclusion The importance of understanding PA and P.E. participation among children with disabilities cannot be overstated. Through a comprehensive examination of accelerometer-assessed PA and quality participation, this study set out to gain a better understanding of the experiences of children with physical and/or sensory disabilities within school-based P.E. in British Columbia. The application of mixed-methods, including accelerometry data and interviews, has provided multifaceted and detailed insights into the PA levels and experiences of these children. The study has found that only a small proportion of participants meet the recommended guidelines for PA, both in daily life and during school hours. This underscores the unique challenges and barriers faced by children with disabilities, emphasizing the need for tailored interventions and support within the school context. These findings hold significant implications for policymakers and decision-makers responsible for shaping children's activity participation in schools. As the research highlights the potential benefits of regular physical activity for children with disabilities and emphasizes the importance of school-based physical activity policies, policymakers can draw valuable insights to inform their decisions and strategies. The qualitative data collected through interviews has provided a deep understanding of the perspectives and experiences of children with physical and/or sensory disabilities during their P.E. classes. Guided by the already established framework by Evans et al. (2018), a hierarchical model with six building blocks fostering quality experiences in parasport, the study findings revealed a diverse range of experiences and perspectives among children with physical and/or sensory disabilities in their P.E. participation. The quality of their participation displayed variability, with both positive and negative elements observed across various themes, except for the theme of 'meaning.' Notably, the theme of 'meaning' consistently emerged as positive, 64 indicating that despite encountering challenges in other aspects, these children found purpose and significance in their P.E. experience. This highlights the potential for P.E. to hold a profound and meaningful role in the lives of children with disabilities, offering them a sense of purpose and accomplishment. This finding will be of the interest to educational institutions and policymakers to prioritize and support P.E. for children with disabilities, creating an inclusive and supportive environment that fosters their overall development and quality participation. Integrating qualitative and quantitative research methods has been a valuable approach in gaining comprehensive insights into the thesis research questions. Despite some limitations, this thesis lays a strong foundation for future research and intervention development. By addressing the specific challenges faced by these children, we can strive to create a more equitable and empowering educational experience for all students. In conclusion, this study contributes valuable insights into the experiences of children with physical and/or sensory disabilities in the context of P.E. participation. 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Principal Investigator Christine Voss, PhD Assistant Professor, Department of Pediatrics Faculty of Medicine, University of British Columbia (UBC) Centre for Chronic Disease Prevention and Management (CCDPM) Reichwald Health Sciences Centre 1088 Discovery Avenue Kelowna, BC; V1V 1V7 Phone: (250) 807-8042 Email: christine.voss@ubc.ca Co-Investigators • Aleksandra Jevdjevic, Graduate Research Assistant, SCI Action Lab; School of Health and Exercise Sciences UBC-Okanagan Graduate Student • Brianna Tsui, Graduate Research Assistant CCDPM; UBC Experimental Medicine Graduate Student • Kathleen Martin Ginis, PhD, Professor, Faculty of Medicine, UBC, School of Health and Exercise Sciences UBC-Okanagan; CCDPM • Kelly Arbour-Nicitopolous, PhD, Associate Professor, Faculty of Kinesiology & Physical Education, University of Toronto • Eric Bennett, PhD, Assistant Professor, School of Kinesiology, UBC Study Team Members • Owen Kwok, Student, School of Kinesiology • Kylie Johnston, Research Assistant • Ty Sideroff, Research Assistant • Alexis Genereaux-Guidi, Research Assistant Why are we doing this study? Currently, children with disabilities living in Canada are not getting enough daily physical activity. Physical activity provides all children with health benefits, which can persist into adulthood. It is also known that parents can play a role in their child’s physical activity behaviours at home and in the community. In this study, we hope to learn more about where and when children with disabilities are being active. This is important information which we hope can be used in the future to help children with disabilities to be physically active. The overall aim of this study is to provide more insight on physical activity behaviours in children with disabilities and to test the feasibility of using ‘qualitative-geospatial research methods’. This refers to using a combination of wearable devices that measure where a person is active, as well as interviews during which we will discuss and interpret the information from the devices. 73 We are inviting you (parent/guardian) and your child with a disability (between 7 and 15 years old) to participate in this study. To participate, both you and your child need to be living in the same household in British Columbia. For this study, you will be asked to fill out a short questionnaire. Your child will wear measurement devices for 7 days to track their daily physical activity and the locations they visit. Both you and your child will participate in a 1-hour online interview. The purpose of the interview is to learn more about the contexts and reasons for your child’s physical activity behaviour. We are interested to investigate where your child was active when wearing the measurement devices. There is one substudy for children with developmental disabilities, and one substudy for children with sensory and/or physical disabilities (the current study). We hope to have 15 children and 15 parent/guardians participate in each sub-study. Who is funding the study? This study is partially funded through a seed grant from BC Children’s Hospital Research Institute and the Principal Investigator’s start-up funding. The funders have no input on the how the study is being conducted or how the results are presented. What happens if you say “Yes, I want to be in the study”? 1) PROVIDE CONSENT. Take time to read through this consent form and discuss this study with your family members. You will need to explain what the study involves to your child. We will provide you with a script to help you explain the study to your child. It is up to your child to decide if they want to be in the study or not, even if you want them to be in the study. If you or your child have any questions about the study, please contact us before you make a decision on participating in the study. We will be available to answer any questions by email, phone or zoom – whichever you prefer. You will be emailed a link to an electronic consent and an electronic assent form, which will be on Qualtrics, a UBC online survey tool. Qualtrics is used for research at UBC since it keeps your information secure and protected, while ensuring that your information stays within servers in Canada. If you are unable to access the electronic consent form, we can mail you a paper copy. 2) COMPLETE AN ONLINE QUESTIONNAIRE. You will fill out an online questionnaire via Qualtrics. The questionnaire will ask questions about you, your child, your perceptions about your child’s physical activity behaviours, your parenting physical activity practices, your child’s school and your child’s recreational physical activities. Your responses will be kept confidential. This questionnaire takes approximately 20 minutes to complete. 3) WEAR MEASUREMENT DEVICES FOR ONE WEEK. Wearable measurement devices in this study will include a GPS device, an accelerometer and a Fitbit. For this study, we will not use the GPS function on the Fitbit devices because collecting GPS information from a Fitbit device shares highly sensitive GPS tracks with Fitbit Inc. Also, we cannot retrieve high resolution GPS coordinates from Fitbit, which we need to properly analyze GPS data. Finally, enabling the GPS function on a Fitbit uses up a lot of battery on the device. This is why we will use a separate GPS data logger for this study. We also use an accelerometer device in addition to the Fitbit tracker to learn more details about your physical activity behaviours than the Fitbit is able to capture. After you provide consent for you and your child to participate in the study, we will mail you a package with the wearable measurement devices. What you need to know about these devices is outlined here: 74 i. You will receive three devices: a GPS device, and accelerometer and a Fitbit. All devices need to be worn together for 7 consecutive days. ii. Fitbit Device: This device will be worn around the wrist and is like a watch (as shown in Figure 1). The Fitbit device will track your child’s step counts and heart rate. Using a Fitbit device requires an active Fitbit account where information from the device is actively synched to the account. We will offer to create an anonymous Fitbit account for your child (with an anonymous email address) to protect your child’s identity. You can also choose to use your child’s real information if you prefer once you have fully read and understood Fitbit Inc.’s privacy policy. iii. Accelerometer and GPS Device: These devices will be attached to a belt, which is worn around the hip (as shown in Figure 2). The accelerometer will measure your child’s movement. The GPS device will track your child’s location and will not transmit data throughout the 7-day period. We will only be able to retrieve this data after we receive the GPS device back from you. iv. Your child will be able to move around freely throughout the study since the devices are very light and will not restrict your child’s movement. The GPS device weighs <110 grams, the accelerometer weights <20 grams, and the Fitbit weighs <30 grams. v. The devices are not waterproof and cannot be worn during water-based activities such as showering, bathing, swimming, etc. The package will include written instructions on how to charge and use the measurement devices. We will also provide you with a cable to charge the GPS device. The GPS and Fitbit devices will require charging every few days. The accelerometer will not require charging. An activity log will be provided for your child to fill out for 7 days when they are wearing the measurement devices. You may need to assist your child in completing the log. Each day this should take around 5 minutes to complete. We will ask your child to write where and when they went each day such as 8:30-9AM drive to school, 9AM-3PM at school, 3PM-3:30 drive home. We will also include a pre-paid envelope for you to mail back the GPS device and its charging cable, as well as the completed activity log. This envelope can be dropped off at any Canada post mailbox. 4) ONLINE INTERVIEWS. You and your child will be asked to participate in a 1-hour online interview on Zoom with a researcher. When you sign onto Zoom you are asked not to use your real name. Instead, we will provide you with a pre-assigned study name that you will use on Zoom for the online interview. You also have the option to keep your camera turned off. During the interview, you and your child will share your experiences regarding your child’s daily physical activity behaviours and where they went during the time, they wore the measurement devices. The Zoom interviews will be audio recorded and will be kept confidential. We will not share anything that you say in these interviews with anyone outside of the study team. What happens to the results? 75 The results of the study will be presented in the Co-Investigator, Aleksandra Jevdjevic’s, UBC graduate thesis. The graduate thesis is a public document that will be available online on UBC cIRcle, which houses open access digital materials created by individuals at the university. Results may also be shared with the Disability Foundation and will be presented to an Accessible Community Forum with ConnecTra. The results will also be presented to researchers, students, and health practitioners at UBC Okanagan and BC Children’s Hospital. These results will be based on the group findings from the study. Maps of individual GPS tracks may only be used in presentations if they do not contain any identifying information, such as street names. Quotes from individual participants may be used but will not be linked to any personal information that would reveal the identify of the participant. You will also receive a summary of your results and your child’s results on their physical activity behaviours from the study. These personalized results will only be shared with you. If you would like us to send you a summary of your results, please indicate this in the consent form and you will receive them via email. Research is a long process, so you will receive these results approximately 6 months after you complete the study. Could being in the study be bad for me or my child? We do not believe that anything can be bad for you or your child during this study. Your data and your child’s data will be kept confidential. However, GPS data are considered identifiable information as they may show your child’s home or school location. The GPS devices we will be using in this study do not transmit data in real time. Your child’s GPS data can only be retrieved by the researchers once they receive the device back from you. The researchers can only retrieve the GPS data by using special software. This means that if the GPS device is lost or stolen, it is very unlikely that someone will be able to retrieve your child’s GPS data. We will offer to register your child’s Fitbit and create an active Fitbit account for them to retrieve their physical activity information. We will replace your child’s name with a pre-assigned nickname and use an anonymous email to protect your child’s identity. You can also let us know if you prefer to use your child’s real information and your real email address for the Fitbit account, but please note that you would be sharing this information with Fitbit Inc. and we cannot control what they do with your information. By having a Fitbit account for your child (with or without real information), you agree with Fitbit Inc.’s privacy policy. We will provide you with a copy of the policy to review before we create your account. Data from your child’s Fitbit account will be transmitted to Fitbit Inc. servers, which are hosted in the United States. Fitbit Inc. has the right to sell and share your child’s data. Any data we collect as part of this study, we will store on a restricted access research drive on a UBC server. Only members of the research team will have access to this research drive. If you have any questions or concerns about data security regarding GPS and Fitbit data, we are happy to help. More information can be found in How will my and my child’s data be protected? What are the benefits of participating? We do not think that being part of this study will help you and your child directly. However, you may learn more about your child’s physical activity behaviours and become more aware of locations where your child is physically active. It might lead you to make changes regarding your child’s physical activity behaviours. We will also learn more about how follow up interviews can help explain GPS information, which may benefit researchers in future studies to learn more about physical activity behaviours in children with disabilities. 76 How will my identity be protected? Your identity will be kept confidential throughout the entire study. For instance, we will assign you and your child a unique study ID. The only way we can identify you and your child’s identity is via a master sheet where we will be able to match your real names with your unique study ID. Only the principal investigator and authorized study team members will have access to this master sheet. Information collected from GPS Devices such as your child’s location can only be accessed by our researchers once, we receive the device back from you. However, authorized study team members will also be able to view your home location when analyzing GPS tracks. We will store the master sheet and GPS data in a folder on the principal investigator’s restricted access research drive (UBC TeamShare – supported by UBC IT). Only the principal investigator and authorized study team members will have access to this folder. When we set up a Fitbit account for your child, we will not use their real name. Instead, we will use a pre-assigned nickname to identify their Fitbit account. Additional information regarding Fitbit accounts was provided earlier in the section Could being in the study be bad for me or my child?. We will use an online survey tool approved by UBC called “Qualtrics”. Qualtrics will be used for you to provide e-consent and to collect basic information from you. Qualtrics complies with the Freedom of Information and Protection of Privacy Act (FIPPA) since it keeps your survey information secure and stores and backs up your information on servers in Canada. We will also use a data management tool approved by UBC called “REDCap”. REDCap complies with FIPPA and is used to retrieve and store Fitbit data. For online interviews we will use a UBC institutional Zoom account, which has servers located in Canada. You will not be asked to use your real name on Zoom. We will provide you a pre-assigned nickname to use on Zoom so that you cannot be identified. We will enable Zoom’s audio transcription during the interview. This means that Zoom will automatically provide us with a transcript (text file) of the interview, which we will receive after the interview. We will also record your audio from these interviews and save them as audio files. Audio files will be destroyed after we have analyzed them, which will be no longer than 6 months after the interview took place. We will move and store all survey data and physical activity data from the accelerometer and Fitbit in a secure UBC Data management tool called “REDCap”. Interview and GPS data will be stored in a folder on the principal investigator’s restricted access research network drive (UBC TeamShare). This folder can only be accessed by the principal investigator and authorized study team members. Limits of Confidentiality At any point in the study, the researchers are required by law to report to authorities if they suspect that a child is being abused and/or neglected (or if there is a risk of this happening in the future). What will you get for taking part in this research study? Your child will get to keep the Fitbit that they will use in this study. You will not incur any costs for being in this study since we will provide you with a prepaid envelope for you to mail back the 77 GPS and accelerometer devices and activity log. If you or your child accidentally damage or lose either device, you will not be asked to replace them. However, if this happens, we will not be able to replace a broken or lost Fitbit device for your child due to limited funding. Who can I contact if I have questions about the study? If you have any questions or concerns about this study, please contact Aleksandra Jevdjevic via phone (250) 878-9959 or email at aleks.jevdjevic@ubc.ca. Who can you contact if you have complaints or concerns about the study? If you have any complaints or concerns regarding your rights about your experiences participating in this study or as a research participant please contact the Research Participant Complaint Line in the UBC Office of Research Ethics at 1-877-822-8598 or the UBC Okanagan Research Services Office at 250-807-8832. You can also contact the Research Complaint Line by email (RSIL@ors.ubc.ca). When you are reaching to any of these contacts please reference the study number H22-00842. 78 CONSENT AND SIGNATURE By checking each box and signing below you acknowledge that: • You understand that it is entirely up to you to take part in this study. You can refuse to take part in this study. At any point during the study, you can decide to pull out of the study without giving a reason. • You have a copy of this consent form to keep for your own records. • You and your child had enough time to ask questions about the study and to think about whether you want to participate in the study or not.  I provide consent for myself to participate in this study  I provide consent for my child to participate in this study Family Contact Information Email address House number and street name City Province Postal Code Do you want a copy of your child’s results?  Yes  No Name of child (print first and last name): ___________________________ _______________________________ ______________________________ Name of the person providing consent Date of consent obtained (mm/dd/yy) (print parent/guardian’s first and last name) _______________________________ Parent/Guardian Signature Future Studies After this study, the research team may want to investigate more questions that require future research studies. Would you like to participate in future studies? There is no obligation to participate in future research.  Yes  No 79 Appendix B Assent Form Feasibility of qualitative-geospatial methods to investigate physical activity behaviours in children with disabilities in British Columbia (Sensory/Physical Disabilities) Invitation I am being invited to participate in a research study. This study will find information about physical activity in children like me. I do not have to participate in this study if I don’t want to. No one will make me do this study. I do not have to do the study even if my parents want me to be in the study. I can ask my parents or the researchers any questions. Why Are We Doing This Study? This study will help us learn more about physical activity in children with disabilities who are living in British Columbia. We want to learn about where, when, and why children like you are active. What Will Happen in This Study? 1) My parent/guardian will answer questions about me. It is important that I know that my parent/guardian will do this even though I will not answer these questions. 2) I will wear a Fitbit, an accelerometer and a Geographic Positioning Systems Device (GPS) at the same time for 7 days in a row. I will wear a Fitbit on my wrist, which will keep track of my steps and heart rate every day. I will wear a GPS device and an accelerometer device on a belt around my waist. The GPS device will track my location to places that I go to each day. These devices will still let me to move around. The GPS device may feel heavy around my waist. The devices are not waterproof, so I need to take them off when I’m in the shower or if I go swimming. 3) My parent/guardian will write down where, when and what I did each day when I am wearing the devices. 4) I will do an online interview with my parent/guardian. I will answer questions about what I did and where I went when I wore the devices. Can Anything Bad Happen to Me? The researchers will set up an anonymous Fitbit account for me or they will use my real information if I agree with my parent to let them use my real information. Fitbit Inc. will have access to my Fitbit information. Who Will Know I Am in the Study? 80 No one besides the researchers will know your answers or your parent/guardian’s answers to the questions that we will ask you. Only the researchers and your parent/guardians will know that you took part in the study. What Do I Get for Being In This Study? I will receive a Fitbit from this study that I will get to keep. Who Is Doing This Study and Who Should I Contact? Dr. Christine Voss with the help of Aleksandra Jevdjevic from the university will be doing this study. They will answer any questions that I have about the study. I can contact them at (250) 878-9959 or aleks.jevdjevic@ubc.ca . Who Do I Contact if I Have Questions or Concerns About My Rights As a Participant? I can call the Research Participant Complaint Line in the UBC Office of Research Ethics at 1-877-822-8598 or UBC Okanagan Research Services Office at 250-807-8832. I will give the Complaint Line staff the study number H22-00842 when I call them. ASSENT FORM As a participant in this study I agree to: 1. Wear a GPS device, and accelerometer device and a Fitbit for 7 days 2. Participate in an online interview Circle an emoji below: Yes No _______________________ _______________________________ ____________ Participant Signature (child) Printed Name (First Name, Last Name) Date Appendix C Demographic survey 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 Appendix D 97 98 99 100 101 Appendix E Interview guide INTERVIEW GUIDE The following questions represent an overarching agenda for interviews with participants. The questions will be pursued flexibly and may be altered and added to over time as different themes are discussed by participants. Icebreaker Questions 1. What is your favourite food? 2. If you could travel anywhere in the world, where would you go and who would you travel with? Questions about child’s lived experiences about daily physical activity 1. Tell me about your day from looking at this map. a. Who were you with when you visited this location? b. Does this person usually go with you to these locations? c. What activities were you doing when you were at this location? d. Can you describe the locations that you visited on this day? 2. Can you tell me about the activities that you did at these locations? a. How often do you go to this location to do this activity? 3. What did you like most about visiting these locations? a. Why do you like these aspects of the location? 4. What did you like least about visiting these locations? a. Why did you not like these aspects of the location? b. What challenges did you encounter at these locations? 5. Was there anything you wanted to do at these locations, but couldn’t do? a. What type of activities could you not do? b. What stopped from doing these activities? 6. How did you get to and from these locations? a. Who were you with when you were traveling between these locations? 7. What is your favourite activity during PE classes? 102 8. Do you usually play with your friends? 9. What sports/activities/games you don’t like to play during PE classes? Why? 10. What sport/activities/games you would like to play during PE classes? Questions about Parent’s Perceptions of their Child’s Physical Activity 1. Tell me about your child’s day based on this map. 2. Tell me about locations that meet your child’s physical activity needs. a. What aspects of the location facilitate your child’s physical activity? 3. Tell me about locations that do not meet your child’s physical activity needs. a. What aspects of the location hinder your child’s physical activity? 4. What are your perceptions about your child’s physical activity during school (e.g., recess, physical education class)? Is there indoor play space available for active play/sports? 5. What are your perceptions about your child’s physical activity outside of school? a. What are you looking for in these physical activity programs? b. Tell me more about your child’s physical activity participation in these programs. 6. What concerns do you have about the locations where your child is physically active? 7. What general concerns do you have about your child’s physical activity? 8. Describe your involvement in your child’s daily physical activity. a. Where are you involved? b. How often are you involved? c. Why are you involved?
Thesis/Dissertation
eng
Health and Exercise Sciences
Vancouver : University of British Columbia Library
Attribution-NonCommercial-NoDerivatives 4.0 International
Graduate
Martin Ginis, Kathleen A. (Kathleen Anne), 1968-
Voss, Christine
The extent, context, and experiences of participating in physical education activities among children with physical and/or sensory disabilities
Text