Determinants of participation in leisure activities among adolescents with cerebral palsy

Highlights

• Factors contributing to participation are specific to the type of activity domain.

• Contextual factors relate to participation in social and physical activities.

• Family characteristics relate to participation in several leisure activity types.

• Adolescent's motivation, self-perception and behavior are related to participation.

• Personal preferences may be an important determinant of engagement in activities.

Abstract

Studies have identified restrictions in engagement in leisure activities for adolescents with disabilities. Participation is a complex construct and likely influenced by a variety of factors. These potential determinants have not yet been sufficiently explored in the population of adolescents with cerebral palsy (CP). The objective of this study is to estimate the potential influence of adolescent characteristics and environmental factors as determinants of participation in leisure activities for adolescents with CP. A cross-sectional design was used. Participants were adolescents (12–19 years old) with cerebral palsy. Participants were assessed with the Vineland Adaptive Behavior Scale – II, Gross Motor Function Measure, Gross Motor Function Classification System, Manual Ability Classification System and completed the Self-Perception Profile for Adolescents, Dimensions of Mastery Questionnaire, Strengths and Difficulties Questionnaire, Family Environment Scale, the European Child Environment Questionnaire and the Preferences for Activities of Children. The main outcome measure was the Children's Assessment of Participation and Enjoyment. 187 adolescents (age M = 15.4; SD = 2.2) completed the study. Multivariate models of participation in leisure revealed associations with factors related to the adolescents’ functional characteristics and attitudes, the family environment, socioeconomic status, and contextual factors such as school type, and collectively explained from 28% (diversity of skill-based activities) up to 48% (intensity and diversity of self-improvement activities) of the variance in intensity and diversity in five leisure participation domains (diversity: r² = .33 recreational; r² = .39 active-physical; r² = .33 social activities). Adolescent's mastery motivation, self-perception and behavior were individually associated with participation in different activity domains, but did not strongly predict participation within multivariate models, while preferences for activities were strong predictors of participation in all domains, except for skill-based activities. Engagement in different types of leisure activities is important for adolescents’ development and well-being. Health care professionals should consider adolescents’ and families’ characteristics to promote participation in leisure activities.

Introduction

Cerebral palsy (CP) is the most common type of physical disability affecting children in developed countries (Stanley, Blair, & Alberman, 2000). The focus of health interventions within this population is often focused on minimizing impairments and addressing functional aspects of the condition such as activities of daily living and motor function. However, with the endorsement of the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF) over the past decade, attention has been directed at aspects that may contribute to a more holistic understanding of health. This includes the extent to which individuals have the opportunity to be involved and enjoy leisure activities at home and in the community (Adamsom, 2003, Specht et al., 2002).

It is known that engagement in meaningful leisure activities has several long term physical and mental health benefits for adolescents (Zaff, Moore, Papillo, & Williams, 2003). Studies have identified restrictions in leisure activities as an important issue for adolescents with disabilities and their families (Livingston, Stewart, Rosenbaum, & Russell, 2011). Participation is a complex construct and likely influenced by a variety of factors. During adolescence a series of additional personal and environmental elements are likely to impact participation levels. Individual characteristics and attitudes as well as contextual factors may become more critical. King et al. (2003) have developed a theoretical model of determinants of participation including child, family and environmental factors that may influence level of participation in leisure activities. Further research by the same group has tested this model and showed that factors related to the child such as child's gross motor function, gender, and family factors such as family activity-orientation, socio-economic status and parent educational level predict participation in leisure activities (Law et al., 2004, Law et al., 2006). However, these potential determinants have not been adequately explored in adolescent populations to date. Knowledge of these determinants will be important to guide effective intervention strategies to promote participation.

The primary objective of this study is to estimate the potential influence of both intrinsic adolescents characteristics and extrinsic environmental factors as determinants of participation in different types leisure activities for adolescents with CP. We will test a model of determinants of participation based on the previous proposed models, but paying closer attention to intrinsic (adolescent-related) and extrinsic (family and environment-related) factors that are unique and require special attention during the adolescent years such as perception of self, motivation, individual preferences, factors in the family environment that foster autonomy, social supports and environmental barriers (Fig. 1).