The determining factors in school contexts which lead to active lifestyles among young people with disabilities

Study design

Case studies have been conducted in divers regions of Quebec in order to cover the matter in different geographical settings. Indeed, case studies are suitable for exploratory or poorly documented studies (Roy, 2010). As mentioned by Yin (2009), the case study is popular when studying organizations. In this study, many school organizations (elementary schools, high schools, specialized schools) have been considered in order to cover the topic more broadly.

Two main sources of information have been used to perform the case studies: semi-directed interviews as well as field observations. Such an approach is appropriate for the case study research design (Roy, 2010; Yin, 2009), as it allows for a triangulation of data, thus filling gaps in the method and reducing biases.

Participants

In total, 15 case studies were conducted in 10 different regions of Québec. The schools in each regions have been selected through purposeful sampling. Each case had specific characteristics: grade level, institution type, and geographical area. That variability among the cases allowed to draw comparisons between the different characteristics (Roy, 2010). Three types of institutions have been visited: regular elementary schools (n = 5), regular high schools (n = 6), and specialized institutions which enroll students with disabilities only (n = 4). These schools were chosen in four geographical areas and according to precise characteristics: rural schools with few or no sports programs and activities (n = 2), rural schools with a varied selection of sports programs and activities (n = 4), schools located in urban territory with sports and activities offered within proximity (n = 5), and finally, schools located in outer urban regions within proximity of urban centers (n = 3).

Forty-seven young students were observed during gym class for a total of 267 periods of about 10 minutes (each student was observed for at least 4 periods of 10 minutes). In addition, 52 open-ended interviews were conducted with young people with disabilities (n =10), parents of a child with disabilities (n =8), school principals (at least one in each school), and practitioners (at least one rehabilitation staff or physical educators in each school). Table 1 provides more details on the participants studied.

Evaluation tools

The addition of semi-directed interviews to the quantitative data from the observation grids has allowed to deepen the knowledge.

Analysis

The transcripts were analysed using the analytical questioning method (Paillé & Mucchielli, 2003). This approach involves a systematic process of collecting, regrouping and examining the themes in the verbatim transcription. Each transcript was analyzed line by line independently by two researchers for each category of participant (child, parent, principal, and accompanying professional). Then codes from each pair of researchers were merged to construct common list of codes and themes. This approach has allowed to minimize the biases linked to the researcher (Lincoln & Guba, 1985). These codes and themes were then compared and contrast through re-readings of each transcript. One of the researchers analyzed all the interviews in order to get a broader perspective of the results. NVivo 9 software was used to process the data obtained through the interviews.

SPSS Software (ISM SPSS Statistic 20 version) was used for the quantitative data from the three observation grids in order to process and analyze each case study and discover trends and tendencies. Descriptive and inferential analyses (Chi-square’s and Fisher’s tests) were completed. A mixed analysis was then performed in order to put the qualitative data from the interviews with relation to the data from the field statements.

Ethical statement

All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of Université du Québec à Trois-Rivières (CER-12-178-16.14).

Adapted environment and universal accessibility

The first elements that emerged as determining factors are adapted environment and universal accessibility. Whereas the former directly relates to the physical environment, the latter considers the way activities are being led and animated.

The results from the interviews show how access to adapted infrastructure as well as the matter of transportation and costs associated with it, remain as limiting factors in many schools. Universal accessibility is difficult to achieve in many schools, making it especially difficult for students who use wheelchairs. A school principal expands on the topic: “In terms of adaptation […] I do not believe the school property has been altered in any single way for physical education and sports […] Very few things are done in order to effectively adapt our environment…” (Principal 1)¹

Quantitative data from accessibility grids showed some issues with accessibility across most of the school. Data analysis revealed that five spaces out of the 10 yield an average correspondence ratio inferior to 0.7 based on the scale of importance for visual impairment developed (SIMI).² Moreover, according to the scale of importance for motor impairment developed (SIVI), quantitative data revealed that nine spaces out of 12 have an average ratio of correspondence of less than 0.7 (see table 3).

In regular schools, accessibility mainly means adapting the activities and materials that are already present: “[…] If we don’t have it, we don’t have it […] in terms of adapted material […] we mainly have standard basic material and we adapt the activity to those students.” (Principal 8). Such an approach calls for teachers’ creativity : “I would say people show great imagination when it comes to […] adapting material to […] students with disabilities” (Principal 15). Talking about his experience while playing soccer, a young person with disabilities said: “We take a big ball to play soccer. An exercise ball […] because a small ball goes under my wheelchair” (Student 6). He added: “It’s fun to be active.”

It can, therefore, be said that the issue of space development and accessibility is often dealt with by adapting the way of doing things. Most prominently, planning physical education classes by setting up workshops and by pairing participants appears to be an efficient way of integrating students with disabilities and increasing their participation level. On top of that, observations during physical education classes have shown that subgroups or small groups also increase participation. Indeed, participation is greater when the groups are made up of five individuals or less (47.3%) in comparison with teams of six to 10 individuals (39%).

Furthermore, interviews revealed that specialized material is often scarce in regular schools, simply because of a lack of knowledge. Indeed, many teachers report not being aware of the adapted material that can be found on the market. “I’d say there are not a lot of resources in terms of adapted educative material and ideas” (Phys. Ed. Teacher 2).

Specialized schools, however, tend to have more adapted equipment, which tends to encourage students with disabilities to lead active lives: “I think […] the equipment we’ve made available […] motivates children to push themselves physically […]” (Principal 5). Nonetheless, even if such specialized schools are well-equipped and adapted to students with disabilities, some professionals still deplore some aspects of the infrastructure. More specifically, spaces dedicated to sports and physical activities are often limited, as stated in the following quote: “There are few things which are done effectively to facilitate or modify our environment […] for sports and physical education” (Director 13).

Help and support offered

The nature of the help offered to young people with disabilities greatly affects the quality of their participation in sports and physical activities. Notably, the study revealed that signs of intense pleasure is observed for a total 67.7% of the observational periods, when a specific coaching was offered and youth with disabilities attentive, whereas the level of intense pleasure dropped to 26,9% when there was no specific coaching (See table 4 for more details). This difference is statistically significant (Fisher test, p ≤ 0.000).

However, the form of coaching offered is not necessarily equivalent; it depends on the limitations that are being dealt with. For instance, it seems to be generally detached when in the presence of students with a language disability (see table 5).

The problem seems to be that physical educators are often not very informed of the limitations of their students with disabilities. The study has shown that only 50% of the physical educators interviewed in regular schools knew about the disabilities of their students. Most of the teachers interviewed mentioned that they are not taken into account when elaborating integration plans for these students. A physical educator explains: “[…] the special care counsellor and I often talk about the situation of young people in order to know what their needs are and how to adjust. I haven’t had access to the case files, I don’t even know what they look like” (Physical educator 10). This not only limits the possibility of integrating an objective of increased physical activity within the action plans of students with disabilities, but it also limits their teachers’ ability to adapt the activities due to a lack of knowledge about their situations. Regardless of this, most of the physical educators interviewed have demonstrated commitment in trying to adapt their activities to the needs of students with a disability. They lack, however, the necessary resources and knowledge to adequately do so. Many have claimed that training opportunities and exchanges between physical educators from different school sectors are insufficient as shown in the following excerpt: “I miss seeing other teachers and having the opportunity to talk with them and share our successes” (Physical educator 13).

In specialized schools, students benefit from the presence of a special care counsellor even during periods of physical activity, whereas students receive no such support in regular schools. However, the lack of professional resources for physical education seriously limits the offer of such activities to young people with disabilities. Numerous specialized schools within this study find fault in the fact that they do not have physical education specialists within their team. A special care counsellor from a specialized school explains: “We don’t have a physical educator […] it would be good to have at least one person who is trained in that field, someone who knows what stimulates these kids […] We have lots of equipment […] but very little knowledge.” So, simply having access to material is insufficient. Therefore, it is important to have at our disposal the professional resources in order to facilitate an optimal development of adapted services. Following this idea, many participants argue that the contribution of professionals within the health network widely facilitates the elaboration of appropriately adapted physical activities. Such collaboration makes it possible to offer activities that are well adapted to students with disabilities, as this physical educator explains: “We had already begun a training program with achievable exercises for the students. She (the physiotherapist) came back and students saw her individually to revise their training plans. That way, the exercises are adapted and safe.” (Physical educator 7)

Qualitative results show that parents of young people with disabilities play an important role in helping their children adopt a healthy lifestyle. Parents volunteering in schools can really make a difference when it comes to the implementation of activities, as this principal states: “We are very fortunate to have dedicated parents who help us at the school, because if it wasn’t for them, I don’t know if we’d be able to make it all happen.” (Principal 11)

Unimpaired students can also help their peers with disabilities by supporting them in their practice of physical activity. Many principals and accompanying professionals refer to successful experiences in which students were paired during physical education classes and extracurricular activities: “[…] an activity we call vrai copain (true friend) during which a regular grade 10 or 11 student accompanies a student with disabilities in different types of activities.” (Principal 15). Such approaches appear effective for the inclusion of students with disabilities.

Finally, acquiring a healthy lifestyle really takes on all its meaning when adapted physical activities become accessible outside of school. According to many participants in this study, municipal leisure services as well as community centers play a big part, as this quote shows:

The parents may want to do sports activities with their children on weekends, but this is not always easy to do. They try to join activities, but often, they are not open to them. At (name of the city), it’s interesting because the city not only offers activities for regular students […] there are more and more activities available to young people with disabilities as well […] but for the parents, having companionship and more support to participation would be very useful. (Principal 2)

Such an offer is crucial in order to promote an active lifestyle among young people with disabilities. However, when bearing in mind the economic hardships parents with children with disabilities often go through, such as taking care of their child while working full-time, it becomes obvious that this is not always possible.

Social interactions

Both quantitative and qualitative results reveal that the quality of interactions that students with disabilities have with others while taking part in physical activities, directly affects their level of interest and participation. Indeed, the more they are included into activities, the greater their feeling of belongingness will be, thus increasing their desire to actively participate. Here’s what a student had to say on this subject: “It’s really helpful when someone from the regular program actually offers someone like me, in the adaptation program, to join him in playing sports. Often, they’ll just say: ‘oh, but he always sits and does nothing during gym class.’ People who say that just really don’t know me at all!” (Student 10).

Although there has been some improvement on this point, plenty of progress still needs to be made. Accompanying professionals deplore the fact that, even in this day and age, students with disabilities are often set aside and laughed at:

There are those students who understand them [the disabled] […] and who have a positive attitude towards them. They stand up for them, valorize them, compliment them, etc. But on the other hand, you have those who don’t really have any information about these kids’ condition, so they intimidate them and make jokes of poor taste about them; they’ll do anything to dissociate themselves. It’s sort of black or white. On one side you have those who are friends with them and love them to death, and on the other, you have those who are in fact scared, so they tease them and generally try to avoid them. (Physical educator 10)

Such intricate relationships often lead to a marginalization of students with disabilities during physical activity. This is especially true in the case of team sports, in which the objective is competitive. A teacher says: “[…] generally, these students will be put aside during the practice of team sports” (Physical educator 12). The quantitative data have shown the group dynamic to be distant from the observed students with disabilities for 40.8% of the observational periods. Those who suffered the most from such seclusion were generally students with autism or with language impairments. Students seemed to have less understanding of non-visible limitations, therefore, less sympathy.

The attitude of regular students toward their peers with disabilities also varied according to the type of school studied. For instance, the quality level of the social interactions varied significantly (p = 0.000) between regular elementary schools and regular high schools. Indeed, elementary school groups were observed as being distant towards the young people with disabilities for 53.1% of the observational periods, whereas this average dropped to 17.6% in high schools (see table 6). It is also notable that the quality of interactions was qualified as distant for only 11.6% of the observation time in rural schools with few or no sports programs and activities, whereas the variable for the three other subgroups averaged 55.8%.

The way an organizer directs a given activity can have an impact on this situation, as this example shows: “[…] but this is my job to be able to say […] ‘Listen, I told you that all five of you have to get involved. But you just play with four and put one aside, you did not respect the instructions’” (Physical educator 12).

The involvement of those without disabilities contributes to integrating those who have one. Awareness-raising measures and information for the students without disabilities, as well as for their parents, would play a huge role within this context. A principal explains: “One of the chapters in my educational book is to accept; […] it’s about trying to live everybody’s differences, whatever they may be.” (Principal 1). Activities where young people without disabilities live the experience of having a disability by taking part in adapted activities have proven to be interesting avenues for raising awareness.

It may be difficult for students with disabilities to develop bonds in regular schools, but that doesn’t mean specialized schools do not face issues of their own. It is true that such specialized schools provide more adapted services, but the flip side is that students attending these schools are secluded from their neighborhood schools, making it difficult for them to make friends in their neighborhood. Regarding this, a parent indicates: “If he had friends in the neighborhood whom he liked and who practiced sports, he would probably get into them as well.” (Parent). Families with children with disabilities often suffer from such isolation. Distinctive measures which would facilitate and encourage out-of-school relationships as well as help build connections between parents with children with disabilities would, therefore, be helpful. A principal from a specialized school expands: “These are often very isolated families. They come from all over and, it isn’t like when you stay in your neighborhood and everyone from the area goes to the same school and knows each other […] Families of our students don’t usually mingle because they live too far from one another” (Principal 4). Therefore, supporting links among families would also be beneficial to these parents who experience severe isolation.

To summarize, the quality of social interactions greatly impacts the likeliness of young people with disabilities to adopt healthy lifestyles. Therefore, the quality level of the experience appears important to consider more broadly.

Quality level of the experience

The quality of the experience that young people with disabilities live when involved in an activity can be very decisive in helping them take steps towards healthier, more active lives. It includes the level of pleasure they experienced in the activity as well as the opportunity they had to reach an optimal experience that mobilized their potential. In fact, many of the interviewed subjects have gone on to claim that the significance this has for the students is, in fact, much broader than that.

They have […] the possibility […] of accomplishing something […] the possibility of discovering new sensations […] which they don’t experience in their everyday life […] I’ll use the example of swimming […] it’s their favorite activity […] and the reason is simple […] it’s a sensation that they haven’t often experienced in their lives.” (Principal 15)

A teacher also adds: “[…] it’s like for any other young person. It’s the feeling of belongingness, being active and having fun while doing it” (Physical educator 7). Talking about her daughter, a parent specifies: “[…] she’s part of a team and participates in tournaments. It’s all about having fun with the friends she makes […] even though she has a limitation, she’s still as actively involved as everyone else on the team.” Physical education teachers describe how engaging in sports can become a motivation to get up in the morning and go to school: “If it wasn’t for extracurricular sports, some of these kids wouldn’t even be here.” (Physical educator 10)

Finding a physical activity which is suitable and adapted to a young person with a disability is central in helping them develop an interest in it. A student explains: “I don’t like soccer so much because I can’t really play it. The cardio room is much more suitable for me and I like it.” (Student 10). Many accompanying professionals emphasize the importance of focusing on the young people’s capacities rather than their limitations: “We incite everyone to do their best. […] Each child with disabilities does it their way in accordance with their potential.” (Principal 6). A teacher explains that individualized approaches are more appropriate: “In physical education classes, we look at the student […] according to what they do and progress according to their capacities.” (Physical educator 12)

The quality level of the students’ experiences was analyzed during the case studies. The results have shown that for 79.6% of the observational time, students with disabilities have shown signs of moderate to intense enjoyment, which is very positive. In addition, the activities seemed to be optimized for participants with disabilities for an average of 68.1% of the observational periods.

Certain factors appear to optimize the quality level of the experience. Efforts to include participants with disabilities into the activity and to increase their sense of belongingness to the group, directly influence their level of participation. The study reveals that when participants with disabilities had good relationships with their peers without disabilities, their participation level was increased. The data also shows that 65.3% of intense enjoyment among young people with disabilities has been observed during active group activities.

It would be important to develop approaches that would bring students with and without disabilities together during physical activity. Furthermore, the study has shown that the totality of the practiced adapted activities observed do not reduce the amount of pleasure and enjoyment experienced by students without disabilities. Therefore, physical instructors should place emphasis on the importance of accepting and including students with disabilities so these young people don’t get the feeling of failure or of being left aside. In addition, the presence of an instructor specifically assigned to students with disabilities seems to have a substantial impact on the experience they live.

Adaptation of the environment and universal accessibility: Known factors which are not always taken into consideration

This study has shown the necessity of adapting the environment and equipment for students with disabilities. It’s also exposed that the lack of funds, the deterioration of sports grounds, and the lack of knowledge about students with disabilities’ specific needs, can explain why schools are not always offering suitably accessible activity environments and adapted material. Nonexistent or inadequate layouts have proven to have a negative impact on the autonomy, the perseverance, and the inclusion of students with disabilities. As Saebu (2010) recalls, people with special needs have to constantly deal with extremely limiting factors (fatigue, lack of energy, injuries, medical complications), which can be severely amplified when the layout of their environment is inadequate.

Universal accessibility also requires the adaptation of the methods used by teachers. Their creativity becomes a major tool when offering adapted activities that are suitable and pleasurable for everyone. This confirmed the need to adapt the activities in order to maximize the potential of people with disabilities (Fougeyrollas, 2010). Pairing students or placing them in small groups can be remarkably helpful. Adapting activities to those with disabilities requires better training in physical education and a more effective sharing of information about the students’ limitations and needs. This is coherent with the results from other studies (Bouvard, 2007; Bourgoin, 2007; Rimmer et al., 2004) and introduces the crucial role of support. There is more to be done by informing the accompanying professionals about adapted materials available and approaches specifically designed for young people with disabilities.

Available support and adjustments to be made in terms of instructorship

Besides the consideration of adapted materials and suitable layouts of sports grounds, the presence of specific instructorship can have a substantial impact on the experience of a student with disabilities during physical activity as well as on their level of enjoyment. Without denying the importance of the physical environment, Bouvard (2007) considers the importance of the quality of the help offered to people with disabilities. Indeed, it has an impact on the social and psychological benefits from the activities. The study has also shown how students with language deficiencies seem to be more often than not participating in physical activities without any specific instructorship. Given the conclusions of Bouvard (2007) and Bourgoin (2007), this supports the fact that the visible appearance of a given disability and the social representation of the disability the teacher in charge may have, will influence the nature of the support offered.

Results obtained through the study point in the same direction as the ideas of Goodwin (2001) and those of Bui-Xuân and Mikulovic (2007), to the effect that non-oppressing help can have a tangible effect on the level of involvement in an activity of a student with a disability. Indeed, data emerging from the observations show the positive impact of specialized support. Bui-Xan and Mikulovic (2007), as well as Fougeyrollas (2010) have acknowledged the importance of stimulating adapted coaching which is oriented around the capacities of the students instead of performance.

However, adjustments need to be made in certain sectors in order to fully meet the needs of these students. Many of the observed teachers in regular schools do not know much about the disabilities of some of their students, making it difficult for them to offer adequate support. Furthermore, many of these teachers deplore the lack of information, but show interest in learning more. Opportunities for exchange between accompanying professionals and the pooling of know-how need to be systematically developed in our schools.

Present social interactions, which are not universally accessible

Physical education classes bring forth many opportunities for social interactions between students with and without disabilities. This study has shown that interactions are often intermittent and are not necessarily available to every student with a disability. Moreover, they do not always generate the same impact on every student. Indeed, the group’s social interactions towards students with disabilities are often limited or distant, notably towards those with developmental or language disabilities. This is even more worrisome when we consider the concepts drawn by Junker and Carlberg (2011), which highlight the importance of including students with disabilities within the group during periods of physical activity. This is fundamental in order for these students to gain all the social and physical benefits from the activities. According to Buffart et al. (2009), the sense of belongingness brings these students a feeling of pleasure, which is essential in order for them to desire to partake in such activities again. Hassan et al. (2012) also add that feeling recognized as part of a group helps increase the participants with disabilities’ self-esteem.

Results show the current urgency for teachers to raise awareness among students towards those with non-visible disabilities such as developmental or language deficiencies. This is important if we want these students to remain interested in pursuing physical activity. The Direction Régionale de la Jeunesse et des Sports (2007) has stated that awareness-raising efforts need to be systematic and based on the teacher being a positive leader who reinforces certain rules (such as the obligation of passing to every player). Moreover, the study has shown that adapting an activity to students with disabilities (such as playing soccer with a bigger ball) does not compromise the amount of pleasure other students have. This correlates with Fange et al. (2002), who pointed out that organizing unacquainted physical activities can be beneficial on many levels. Indeed, such activities can help support the inclusion of students with disabilities within activities while raising awareness among regular students about their peers with disabilities. The study has also shown how reducing the number of participants in an activity can be beneficial. Breaking the group into smaller groups or into pairs can indeed be very helpful in achieving higher involvement from students with disabilities as well as raising awareness among regular students. Following the ideas of Hassan and colleagues (2012), it can be stated that the activities which involve interactions between participants, are beneficial in encouraging students with disabilities to participate, especially when the groups are small (10 individuals or less).

On a different note, students with disabilities might develop some good social connections at school, but these do not necessarily thrive in their everyday life. This is even truer for those who attend specialized schools, since their classmates are usually not from their neighborhood. These students are often affected by social isolation. Measures that promote physical activity among young people with disabilities need to be taken within the community.

An experience that proved to be generally positive

The analysis of data puts into perspective the importance of pleasure during the practice of sports and physical activity with relation to the expectations and aspirations of students. The correlation between personal interests and proposed activities appears crucial. King et al. (2009) show the importance of interests according to age and abilities in the adoption of physical activities among young people with disabilities. These statements confirm the necessity of pleasure and enjoyment, as Howie et. al. (2012) have brought forth. For these authors, pleasure and enjoyment are important sources of motivation for young people with disabilities to pursue physically active lives. King et al. (2014) argue that the quality of the experience is more important than quantity. They add that optimal participation is defined by the quality of the interaction between young people with disabilities and their environment. King et al. (2013) add that the activity must be meaningful.

Interactions during physical activity are another important aspect to consider. For most students, they only mildly influenced the amount of pleasure expressed. For others, however, they directly correlated with their sense of enjoyment. Results have shown that young people with an autism spectrum disorder or language disability show more signs of indifference when an activity does not call for interactions. As Bouvard (2007) and Bourgoin (2007) explained, the non-visible aspect of such disabilities might contribute to this situation. In addition, qualitative data shows that friend relationships are important for these people in order to engage in sports and physical activities outside the school setting.

Results have also proven that teachers play a key part in making physical activity a good experience for students with disabilities. Although proven to be beneficial, it is important that such help not diminish their autonomy. Goodwin (2001) explains how too much help can actually negatively affect a person with disabilities’ physical autonomy. These observations have also shown that active help and support during the first few minutes can really help someone with a disability to get involved in the activity. In this case, the teacher helps a given student integrate the group. Increased participation and expressed pleasure are practically assured when such integration is followed by positive support. Considering the results obtained in regional schools, where students with bigger limitations benefited from little specific instructorship during activities and yet seemed to feel a certain pleasure, it is important to put this analytical statement into perspective. This can be explained by the proximity between families in such regions as well as their strong sense of exchange and support. The measures put in place in some schools seem to be beneficial for students with and without limitations. Marcellini, Leselec, and Gleyse (2003) also acknowledge the important role local communities play in the growing up and development of young people with disabilities.

Many school principals call for the development of partnerships with the community. This is important when taking into consideration the heavy load parents who have children with disabilities have to bear and the support they might need to overcome it. Devine (2004) explores the role of inclusive approaches that allow for greater integration and shows the importance of allowing young people with disabilities to develop to their full potential within the community. Scholl, Dieser, and Davison (2005) have proposed a model that allows greater integration of young people with disabilities by taking into account their needs and those of their families through the involvement of specialized leisure professionals.