School-Based Physical Activity, Its Correlates and Efficacy of Interventions among Learners with Physical Disabilities in Kenyan Special Secondary Schools
Gaita, Njenga Daniel
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The WHO rates physical inactivity as the fourth global risk factor for mortality. Children and youth with disabilities are twice at risk of inactivity and sedentary lifestyles concomitant with related comorbidities. This necessitates evidence-based physical activity (PA) promotion strategies implementable in schools where these individuals spend most of their time. This two-phased study aimed at assessing the PA behaviour and its correlates and the effectiveness of selected school-based PA promotion interventions among learners with physical disabilities in Kenyan special secondary schools. Phase 1 was a cross-sectional descriptive survey among a census sample of 650 learners. The learners’ PA behaviour, attitudes towards PA, satisfaction with use of assistive mobility devices (AMDs) and the influence of PA on their health-related quality of life (HRQoL) was assessed using the Youth Activity Profile, the Negative and Positive Attitude scales, the Assistive Device User Satisfaction tool and the Paediatric Quality of Life Inventory (PedsQLTM) respectively. Phase 2 of the study was a three-arm cluster randomised test among 45 purposively sampled learners using manual wheelchairs for mobility. It assessed the effectiveness of PA literacy, peer mentoring and adult mentoring in promoting PA. Changes in PA were ascertained by assessing the arm strength and cardiovascular endurance of the participants. Data was collected using the handgrip dynamometer, the 10-m wheelchair ride test and subsequently analysed using General linear mixed model (fixed and random effects) at p ≤ 0.05. The effectiveness of the interventions was also assessed using focus group discussions which were analysed thematically. Results from phase 1 established that the learners were more physically active than sedentary during a school-day. Engagement in PA was higher during out of school-times compared to school-times. Learners participated in more unstructured and unsupervised PA during out of school-times. The study also established potential for PA in recess, lunchtime and PE lessons. Using Univariate Analysis of Variance regression tool, the study established that attitudes towards PA largely influenced the leaners’ PA behaviour (p<0.001, ƞ2 = 0.045), an influence that transcended gender, the use of AMDs and learners’ class level. Further, the study established that PA behaviour positively predicted HRQoL (p<0.001, ƞ2 = 0.044). Results of phase 2 showed that the PA promotion interventions increased engagement in PA among learners who used manual wheelchairs. These learners also reported improved independence and quality of life. The study concluded that learners with physical disabilities were relatively physically active and were likely to engage in more PA during out of school-time. It concluded that their PA was likely to be influenced by their attitude toward PA more than by other selected correlates. The study also concluded that their PA was likely to improve with interventions that target enabling, predisposing and reinforcing factors of PA behaviour. It thus recommends implementation of strategies which enhance predisposing, enabling and supporting determinants of PA in all school-times.