How do individuals with mental health disorder and spinal cord injury gain access to participate in voluntary sport groups in Switzerland?

Abstract

Introduction Physical activity (PA) is crucial to physical and mental health in various populations, including individuals with disabilities (IWDs). IWDs are at higher risk being physically inactive, developing non-communicable diseases, and experiencing major negative health consequences due to inactivity than the general population (Martin Ginis et al., 2021). One possibility to be physically active is through voluntary sport groups (VSGs) in sport clubs. However, physically, IWDs are significantly less active (also in VSGs), than the general population (Bickenbach, 2011; Martin Ginis et al., 2021). They seemingly have restricted access to (adaptive) VSGs. This is also the case for individuals who have a spinal cord injury or are dependent on a wheelchair in their daily lives (e.g. due to a chronic illness) (ISCIs), and individuals with mental health challenges or disorders (IMHDs), as they face specific challenges and barriers in accessing and participating in PA programs (Firth et al., 2016; Jaarsma et al., 2014). However, little is known about how those target groups gain access and why or why not they join VSGs. Research so far has looked mainly at what factors influence successful participation in (leisure time) PA for ISCIs (Jaarsma et al., 2014; Williams et al., 2014) and for IMHDs (Epiney et al., 2023; Firth et al., 2016), but not the process of access. To investigate how the access into sport, or VSGs, might happen, we use the concept of sport-related socialization (Burrmann, 2021). The theory addresses influencing factors on an internal reality (intrapersonal level, e.g. motivation, health) and an external reality (interpersonal level, e.g. social support; organizational level, e.g. accessibility and location of VSGs). Thus, the aim of the present study was to investigate how ISCIs and IMHDs gained access to VSGs and which factors are relevant for the access from an active participant’s and a coach’s perspective, aiming to get a greater comprehension of how access to VSGs can be increased.

Methods A qualitative approach was chosen to investigate the above-mentioned aim. Participants were recruited via the Swiss Paraplegic association, offering adaptive VSGs for wheelchair users, and PluSport, offering adaptive VSGs for IMHDs in Switzerland. A purposive sampling approach was applied to achieve maximum variation sampling (Smith & Sparkes, 2020). The aim, in line with research in the field and with expert literature, was to recruit at least five participants per subgroup, leading to a final sample of ten athletes (5 ISCIs, 5 IMHDs) and ten coaches (5 of VSGs for ISCIs, 5 of VSGs for IMHDs) (Hennink & Kaiser, 2022; Smith & Sparkes, 2020). The coaches’ point of view was included to have a complementary perspective compared to the athletes to produce comprehensive insights. A semi-structured interview guideline was developed, discussed with experts and tested in a pilot interview (Braun & Clarke, 2022; Smith & Sparkes, 2020). Interviews were conducted during spring 2024 in (Swiss-)German or French. Data were analyzed using thematic analysis with an inductive and deductive approach to be able to identify themes and codes (Braun & Clarke, 2022).

Results In the following, a selection of relevant factors that were found are presented. The results showed that people mostly accessed VSGs through other persons. ISCIs mentioned that they often gained access through the rehabilitation clinic, but none of IMHDs or their coaches mentioned that they gained access through a psychiatric clinic, but often through the institution where they lived. Further, more than half of the participants described that they gained, or coaches that they perceived, the access as self-determined and/or voluntary. As influencing factors on an internal reality, motivation for the VSG was frequently named as hindering or enabling, as well as fears and anxieties as an obstacle to gaining access. Body functions, including health, were mentioned by most of the coaches and half of the participants as influencing their access to VSGs. In addition, openness to new things and other people, as well as previous experience with sport and PA were mentioned as facilitators. On the external reality, social support from the environment was mentioned as important. Additionally, the group constellation, i.e. the people in the group, as well as behaviours of other participants were mentioned as influencing factors for access to VSGs. Then, the coach (behaviour before and during the VSG) was named as an enabler by almost all of the coaches and most athletes. At the organizational level, the type of program was mentioned as influential by all coaches and most athletes. Moreover, the location of the VSGs and for some, the costs were relevant to athletes’ gaining access to VSGs.

Discussion/Conclusion The present study has provided important insights into how IWDs, especially ISCIs and IMHDs, gain access to VSGs. The results revealed important factors in both, an internal reality (e.g. fears and anxieties, motivation) and an external reality (e.g. social support, availability of VSGs). This study is the first to investigate on the access to VSGs for ISCIs and IMHDs. The findings confirm the literature on PA participation and provide new insights, such as the importance of previous experiences with PA. The results may have important implications for service providers for IWDs, such as rehabilitation clinics, clinicians and voluntary sports clubs. Finally, a large-scale survey is needed to confirm the findings, including inactive athletes.

References

Bickenbach, J. (2011). The World Report on Disability. Disability & Society, 26(5), 655–658. https://doi.org/10.1080/09687599.2011.589198

Braun, V., & Clarke, V. (2021). Thematic analysis: A practical guide. SAGE Publications, Inc.

Burrmann, U. (2021). Sportbezogene Sozialisation. In U. Burrmann, E. Emrich, & F. Gassmann (Hrsg.), Sport in Kultur und Gesellschaft. Handbuch Sport und Sportwissenschaft (S. 197–216). Springer Nature. https://doi.org/10.1007/978-3-662-53407-6_15

Epiney, F., Wieber, F., Loosli, D., Znoj, H., & Kiselev, N. (2023). Voluntary sports programs for individuals with mental health disorders: The trainer’s view. PLOS ONE, 18(10), e0290404. https://doi.org/10.1371/journal.pone.0290404

Firth, J., Rosenbaum, S., Stubbs, B., Gorczynski, P., Yung, A. R., & Vancampfort, D. (2016a). Motivating factors and barriers towards exercise in severe mental illness: A systematic review and meta-analysis. Psychological Medicine, 46(14), 2869–2881. https://doi.org/10.1017/S0033291716001732

Hennink, M., & Kaiser, B. N. (2022). Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Social Science & Medicine, 292, 114523. https://doi.org/10.1016/j.socscimed.2021.114523

Jaarsma, E. A., Dijkstra, P. U., Geertzen, J. H. B., & Dekker, R. (2014). Barriers to and facilitators of sports participation for people with physical disabilities: A systematic review. Scandinavian Journal of Medicine & Science in Sports, 24(6), 871–881. https://doi.org/10.1111/sms.12218

Martin Ginis, K. A., Van Der Ploeg, H. P., Foster, C., Lai, B., McBride, C. B., Ng, K., Pratt, M., Shirazipour, C. H., Smith, B., Vásquez, P. M., & Heath, G. W. (2021). Participation of people living with disabilities in physical activity: A global perspective. The Lancet, 398(10298), 443–455. https://doi.org/10.1016/S0140-6736(21)01164-8

Smith, B., & Sparkes, A. C. (2020). Qualitative research. In G. Tenenbaum & R. C. Eklund (Eds.), Handbook of Sport Psychology (S. 999–1019). https://doi.org/10.1002/9781119568124.ch49

Williams, T. L., Smith, B., & Papathomas, A. (2014). The barriers, benefits and facilitators of leisure time physical activity among people with spinal cord injury: A meta-synthesis of qualitative findings. Health Psychology Review, 8(4), 404–425. https://doi.org/10.1080/17437199.2014.898406