Date Presented 3/31/2017
This systematic review used an ecocultural framework to synthesize qualitative data across 11 studies involving decision making of parents, teachers, and other adults around outdoor play for children with disabilities. Results highlight the complexity of the decision-making process.
Primary Author and Speaker: Julia Sterman
Contributing Authors: Geraldine Naughton, Michelle Villeneuve, Elspeth Froude, Shirley Wyver, Kassia Beetham, Anita Bundy
PURPOSE: Play remains an indisputable occupation of childhood. Specifically, outdoor play offers children vast benefits for development and well-being. However, compared with their typical peers, children with developmental disabilities participate less in this important occupation. Additionally, caregiving adults are typically the primary decision makers around children’s play routines, especially for children with developmental disabilities. Thus, decision-making processes of these adults warrant consideration. The purpose of this study was to systematically review and synthesize the results from qualitative studies on decision-making processes of caregivers around outdoor play for children with developmental disabilities, specifically using an ecocultural theory lens.
DESIGN: Seven databases (CINAHL, MEDLINE, Web of Science, ERIC, Scopus, PsycINFO, and SocINDEX) were searched from 1990 to May 2015 using the key terms disability, child, teacher or parent, play, and outdoors. Inclusion criteria required articles to focus on (1) adult decision making around the (2) outdoor play of (3) elementary school–age children with (4) lifelong developmental disabilities. The Critical Appraisal Skills Programme quality of reporting checklist was used to evaluate the transparency of reporting for included studies.
METHOD: Methods for the thematic synthesis were similar to those found in previous predominantly qualitative systematic reviews. The search yielded 761 studies that were reviewed based on title and abstract. After a full text review, 11 predominantly qualitative studies met the inclusion criteria. An ecocultural framework was used for thematic analysis and synthesis across studies. The first level of coding included text within articles that related to decision making around outdoor play. These codes consisted of factors that were classified as primarily barriers, enablers, or motivators within each of the studies. Reviewers then grouped these codes into related subthemes using a hierarchical tree structure, renaming them as needed to capture the meanings of the included initial codes. Finally, the subthemes were placed under layers within an ecocultural model (e.g., child, caregiver, family, or school and societal environment).
RESULTS: Caregivers, families, schools, and communities considered multiple factors in decisions around outdoor play for children with developmental disabilities. Considerations included child and caregiver motivation for participation in outdoor play; social and built environments; familial and school constraints, including time and finances; caregivers’ awareness of opportunities; and child-focused characteristics such as their skills, health, and interests.
CONCLUSION: An ecocultural environment of a child with developmental disabilities interacts dynamically between and within families, schools, and communities, affecting participation in outdoor play. Thus, maximizing benefits from outdoor play may require more holistic, ecocultural approaches. Occupational therapists are uniquely poised to shape caregiver decision making to increase participation in outdoor play by promoting interactions among the community, family and school, caregiver, and child levels. This can include providing training for recreation providers, increasing school and family knowledge of opportunities, coordinating between school and family around outdoor play, and helping families and schools consider the child’s current interests as well as lifelong physical activity and social needs.
References
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Bult, M., Verschuren, O., Jongmans, M., Lindeman, E., & Ketelaar, M. (2011). What influences participation in leisure activities of children and youth with physical disabilities? A systematic review. Research in Developmental Disabilities, 32, 1521–1529. http://doi.org/10.1016/j.ridd.2011.01.045
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