Introduction: Participation is a key therapy and health promotion outcome for children with disabilities. This thesis contributes to childhood disability participation literature by (a) synthesizing evidence on family factors consistently associated with the participation of children with disabilities, (b) providing evidence on characteristics, family circumstances and community-based participation of a nationally representative sample of children with and without disabilities, and (c) identifying factors associated with participation frequency of children with disabilities in community-based social and physical activities.
Methods: A systematic review focusing on family factors consistently associated with participation was completed. This was followed by a quantitative analysis of data from the fifth sweep of the Millennium Cohort Study (MCS5) (2012-2013) which supplied evidence on 1,073 children with disabilities and 11,122 children without disabilities aged 10-12 in the United Kingdom. Chi-squared and logistic regression analyses were used.
Results: Thirty studies included in the review provided evidence on non-modifiable family “status” factors and modifiable family “process” factors. “Status” factors consistently associated with participation were parental ethnicity, parental education, family type and family socio-economic status. Family “process” factors with consistent associations were parental mental and physical health functioning, parental self-efficacy beliefs, parental support, parental time, family preferences, and activity orientation. Quantitative data suggested that children with disabilities were more likely to be boys, have psychosocial and behavioural problems, live in single-parent households and have a parent with a longstanding illness compared to peers without disabilities. They also had greater restriction in community-based participation, especially in social and physical activities. Child psychosocial and behavioural problems, ethnicity, parental education, family income, parental physical activity, parental play of physically active games with a child and parental social support had independent effects on participation frequency of children with disabilities in social and physical activities.
Conclusion: Support services for children with disabilities and their families should be strengthened. Interventions targeting child psychosocial and behavioural functioning and immediate social environment are required to promote children’s participation in community-based social and physical activities. Revisions to the “immediate family” component of the WHO’s conceptual framework for functioning, disability and health of children and youth are proposed.
Keywords: children, disability, characteristics, participation, family factors, environment, community activitie
