It is well established that engaging in a physically active lifestyle benefits the long-term development and well-being of all children and youth. For children living with chronic medical conditions (CMCs), the benefits of participating in physical activity are critically important for achieving positive health outcomes and mitigating the risk of secondary chronic disease and more significant morbidity. Unfortunately, most children with CMCs are insufficiently active to achieve its associated benefits, often citing disease-related barriers to participation. To better understand how children with CMCs navigate their participation in physical activity, the concept of physical literacy can be applied as a helpful lens. In brief, physical literacy describes one’s physical, cognitive, and affective capacities to engage in an active lifestyle. Despite facing unique risks and barriers in active contexts, some evidence suggests that children with CMCs can still achieve or excel in their physical literacy. This suggests that those who are struggling to navigate their participation in an active lifestyle would benefit from potential support in their physical literacy development. However, efforts to intervene could be misplaced or misguided without adequate contextual knowledge about how the lived experiences of children with CMCs inform their physical literacy development.
The overall purpose of this research was to comprehensively examine how physical literacy is developed among children with CMCs. Collectively, this is accomplished throughout the dissertation by contextualising, describing, and reflecting on how children with CMCs develop physical literacy. Margaret Whitehead’s conceptualisation of physical literacy was the guiding framework for this work, built on a philosophical foundation combining monism, existentialism, and phenomenology. A pragmatic approach was applied to guide the research process, employing mixed and multiple methods. This research was conducted with school-aged children, 8 to 12 years old, living with CMCs and recruited from outpatient Cardiology, Endocrinology, Hematology, Cystic Fibrosis/Respirology, and Neurology clinics at a local children’s hospital in Ottawa, Ontario. Where applicable, physical literacy was measured using the second edition of the Canadian Assessment of Physical Literacy. Qualitative methods were strategically applied and combined throughout the research program, including interviews, focus groups, open-ended questionnaires and field notes.
This research was conducted during the COVID-19 pandemic, which dramatically influenced physical activity behaviours worldwide. Thus, the physical literacy development of children with CMCs could only be understood by first acknowledging the relative impact of the pandemic. The purpose of Article 1 was to evaluate and understand how the COVID-19 pandemic influenced the physical literacy development of children with CMCs during the first two years (2020-22). Compared to pre-pandemic matched pairs, the overall physical literacy levels of children with CMCs were significantly diminished during the pandemic, driven primarily by decreases in physical competence and daily behaviour. It was challenging for children with CMCs to play active games in the context of the pandemic, where they had to learn how to navigate additional constraints to prevent the spread of COVID-19. These precautions also constrained how children with CMCs developed social connections, which was cited as a reason that participants felt less motivated to engage in physical activities during the pandemic. Children with CMCs also spoke hesitantly about returning to pre-pandemic activities, as they perceived changes in their physical competence and the participation contexts would make it difficult to be engaged (i.e., mask-wearing requirements, uncertain safety rules, potentially sudden closures). Nonetheless, participants with CMCs maintained high levels of measured intrinsic motivation and confidence in physical activity. Once the pandemic context was better understood, the purpose of Article 2 was to describe the overall physical literacy development of children with CMCs by examining measured outcomes and comparing the experiences and perspectives of those with high and low levels of physical literacy. Most children with CMCs (~80%) were beginning (< 17th percentile) or progressing (<65th percentile) in their physical literacy journey when compared to normative classifications. Total physical literacy seemingly contributed to a sense of self and how participants with CMCs approached new experiences. In the affective domain, attitudes towards physical activity were generally informed by prior experiences, and the meaningfulness of physical activity was more salient than enjoyment. In their physical competence, participants with CMCs found it particularly difficult to navigate bodily self-regulation alongside complex movement patterns and understood the implications of practice for sustained participation in physical activity. Cognitively, it is promising that children with CMCs adopted general definitions of physical activity, recognising the benefits of an active lifestyle for their health, and understood the relative importance of evaluating risks in active contexts. Participants with higher scores spoke more about physical activity experiences where the affective, cognitive, physical, and behavioural domains seemingly overlapped (i.e., curiosity in active settings, valuing practice experiences, performing complex movement patterns in game contexts, etc.). Overall, findings identified multiple areas where children with CMCs may be supported in their physical literacy development, including opportunities to practice bodily self-regulation strategies and develop confidence in risk evaluation.
Finally, the purpose of Article 3 was to reflect upon the acquired knowledge of physical literacy among children with CMCs by observing how it may be applied within a community-based setting. The “I Can Play Anything” multi-sport program was developed for the RA Centre, a community-based recreational facility in Ottawa, Ontario. The program was designed based on the concept of physical literacy and teaching principles drawn from various behaviour change theories, including self-determination theory. Descriptive, reflective and reflexive data were collected using a combination of interviews, focus groups, field notes and open-ended questionnaires. The developed themes represent the combined expectations, applications, and potential implications of the program for children with CMCs, which are: 1) Learning to play, 2) Inclusion supported by individualised variations, and 3) Understanding one’s need for rest. Reported perceptions and experiences within the community-based multi-sport program reflect how children with CMCs may be effectively supported in similar, active contexts.
The final chapter of this dissertation integrates the results from all three articles, emphasising areas of physical literacy development which are particularly relevant to the lived experiences of children with CMCs. Salient ideas discussed throughout this dissertation were recognising and valuing skill progressions developed through practice, the influence of meaningful experiences on active behaviours, self-regulating activity intensities in active contexts, and applying a general definition of embodied participation to physical literacy. My research contributes valuable knowledge to the methodological, theoretical, and practical advancement of physical literacy research, particularly among children with CMCs. This dissertation emphasises and encourages the unique potential for collaboration between the health and recreation sectors to facilitate the ongoing physical literacy development of children living with CMCs.
| Identifer | oai:union.ndltd.org:uottawa.ca/oai:ruor.uottawa.ca:10393/45629 |
| Date | 14 November 2023 |
| Creators | Blais, Angelica |
| Contributors | Longmuir, Patricia |
| Publisher | Université d'Ottawa / University of Ottawa |
| Source Sets | Université d’Ottawa |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
Page generated in 0.0032 seconds