Improving health in children with disabilities: an intervention-development study to support participation in leisure in 8-12 year olds with communication and mobility limitations

Abstract

Introduction: Participation in leisure contributes to children's physical and mental health, subjective well-being, and social inclusion. However, children with neurodisability experience participation restrictions compared to their non-disabled peers. We investigated: (1) what factors influence these children's participation in leisure, (2) what intervention techniques should be used to target these factors, and (3) how should allied health professionals deliver these techniques in community health settings. Patients and method: Focusing initially on children with communication and mobility limitations aged 8-12 years, we drew on the World Health Organization's International Classification of Functioning, Disability and Health, the United Kingdom Medical Research Council's guidance for developing complex interventions, and health behaviour change theory and evidence. We used a quantitative systematic review, a three-stage Delphi study involving children, parents, allied health professionals, short breaks professionals, sports coaches, and researchers, and coproduction workshops with young people. Results: We produced a prototype intervention manual including: (1) a relevant and useful specification of participation in leisure as a health outcome, (2) 19 categories of personal, social environmental, and wider contextual factors influencing participation in leisure, (3) intervention techniques (n=47) for supporting participation, and descriptions of how they can be delivered, (4) seven categories of potential allied health implementation issues, and guidance for addressing these, and (5) animated films illustrating young people's key messages from the research. Conclusion: The myriad of factors influencing participation in leisure necessitated a theoretically-based, clearly specified, and flexible intervention manual that can be replicated and tailored in future evaluation studies and community health settings.