Alexandra Devine1, Aleisha Carrol2, Sainimili Naivalu3, Senmilia Seru3, Sally Baker1, Belinda Bayak-Bush2,Kathryn James2, Lousie Larcombe1, Tarryn Brown2, Manjula Marella1
1 Nossal Institute for Global Health, University of Melbourne, Australia
2 CBM Australia, Australia
3 Fiji Disabled People’s Association, Fiji
In many settings, people with disabilities are marginalised from the socio-economic activities of their communities and are often excluded from development activities, including sport for development programmes. Sport is recognised as having unique attributes, which can contribute to the development process and play a role in promoting the health of individuals and populations. Yet there is little evidence, which demonstrates whether and how sport for development can be disability-inclusive. The aim of this qualitative research was to address this knowledge gap by documenting the enablers and barriers to disability inclusion within sport for development programmes in the Pacific, and to determine the perceived impact of these programmes on the lives of people with disability. Qualitative interviews and one FGD were conducted with implementers, participants with and without disability, and families that have a child with disability participating in sport. Participation in sport was reported to improve self-worth, health and well-being and social inclusion. Key barriers to inclusion included prejudice and discrimination, lack of accessible transport and sports infrastructure, and disability-specific needs such as lack of assistive devices. Inclusion of people with disabilities within sport for development was enabled by peer-to-peer encouragement, leadership of and meaningful engagement with people with disabilities in all aspects of sports programming.
An estimated 15 per cent of the world’s population have a disability. In many settings, people with disabilities are marginalised from the socio-economic activities of their communities. Many do not have equal access to health, education, employment or development processes when compared to people without disability, and are subsequently more likely to experience poverty. People with disabilities are also thought to be less likely to participate in sport, recreation and leisure activities than people without disability.1,2,3
Sport has been recognised by the United Nations as having unique attributes that can contribute to the community development process.4 Sport is universally popular, can play a role in healthy childhood development and contribute to reducing non-communicable diseases (NCDs), which in turn can reduce the likelihood of preventable longer-term impairment and mortality.1,5 Whilst having numerous benefits for the physical and mental health of individuals, it can also be an effective platform for communication of health and human rights messaging as recognised by its inclusion in the Sustainable Development Goals.4,6,7
Participation in sport is recognised as a fundamental right, but its impact on the lives of people with disabilities may be particularly relevant.6 People with disabilities taking part in sport report a sense of achievement, improved self-concept and self-esteem, better social skills, as well as increased mobility and independence.8 Whilst these benefits are similar to people without disabilities, the positive outcomes are thought to be more significant for people with disabilities given their experience of exclusion from other community activities, especially in resource-poor settings.6 Given people with disabilities are known to have an increased risk of developing NCDs,1 -in part due to a lack of access to physical activity – sport for development should be seen as an important opportunity to reduce this risk and promote optimum health.
The benefits of sport for development aim to go beyond individual level physical and mental health with programmes seeking to develop people and communities through sport.9 Promoting inclusive communities should be a part of this. Sport for development programmes which enable people with and without disability to come together in a positive social environment is thought to promote inclusion and empowerment by challenging negative beliefs about the capabilities of people with disabilities.10
NCDs are the leading cause of death and disability in the Pacific Region.11,12 In response, Pacific Island governments with the support of international cooperation have implemented a number of initiatives including sport for development programmes. The few studies examining the effectiveness of sport for development in the Pacific highlight the importance of locally driven programmes that address locally identified development challenges, culturally appropriate and gender sensitive activities,9,13,14 the use of high profile role models and champions,15 and collaboration between development partners, sports implementers and local communities.9
The sustainability and effectiveness of sport for development programmes in benefiting individuals and supporting community development processes was reported to be challenged when these factors were not appropriately considered, as well as insufficient financial and technical capacity to sustain programmes.9 Further, to be effective in the Pacific, sport for development programmes need to address context and cultural specific barriers to participation in sport such as gendered family and work responsibilities, environmental barriers, and lack of motivation and support.13,14 There was, however, limited analysis in these studies about the process and benefits of inclusion for people with disability.
The United Nations Convention on the Rights of Persons with Disabilities (CRPD) describes disability as an evolving concept, whereby disability results from the interaction between persons with long-term impairments and attitudinal and environmental barriers that hinder their full and effective participation in society on an equal basis with others.
Barriers can be attitudinal, related to the built environment; or information, communication and technology; or institutional, such as policies that do not promote equal participation.16 Article 30 of the CRPD requires States Parties to take all feasible steps to ensure participation and equal access of people with disability to recreation, leisure and sport. Article 32 requires all international development programmes to be inclusive of and accessible to people with disability. Greater evidence of how sport for development can contribute to the attainment of the rights of people with disabilities to promote their inclusion within communities and development programmes is needed.3,16,17
In 2013, in recognition of the potential attributes of sport for development and in-line with the CRPD, the Australian Government’s Aid programme and the Australian Sports Commission (ASC) developed a joint ‘Development-through-sport’ Strategy to guide the implementation on the Australian Sports Outreach Programme (ASOP).18 The aim was to utilise sport to contribute to social and development outcomes, and was divided into two main programme components: 1) Country Programmes, and 2) Pacific Sports Partnerships (PSP). The Country Programmes worked with partner governments and/or Non-Government Organisations (NGOs) to deliver inclusive sports-based activities with the aim of contributing to locally identified development priorities. These development priorities included improved leadership; health-related behaviours; social cohesion; and inclusion and promotion of the rights of people with disability.
The PSP was a sport for development programme conducted through a partnership between the ASC, Australian Government, Australian National Sporting Organisations, and their Pacific counterparts. The aim was to deliver sport-based programmes that provided a platform to contribute to development outcomes. The objectives were to a) increase levels of regular participation of Pacific Islanders, including people with disability, in quality sport activities; b) improve health-related behaviours of Pacific Islanders which impact on non-communicable disease risk factors; and c) improve attitudes towards and increased inclusion of people with disabilities.
The ‘Development-through-sport’ Strategy included two strategic outcomes or goals. The first was ‘Improved health-related behaviours to reduce the risk of non-coumminicable disease.’ The second was ‘Improved quality of life for people with disabilities.’ A ‘theory-of-change’ framework was developed for each outcome, the second of which is most relevant to this paper. The ‘theory-of change’ framework for the second outcome includes two intermediate outcomes: 1) improving the way people with disabilities think and feel about themselves, and 2) reducing barriers to inclusion. These intermediate outcomes are then supported by a number of pathways to guide implementation, such as involving people with disabilities in the planning, design and implementation of sport activities (see Fig 1).18
Whilst all the sport for development activities conducted through ASOP were implemented with a core objective of creating opportunities for all people, there was a lack of evidence as to whether and how these programmes supported disability inclusion and contributed to improving the quality of life of people with disabilities. This research aimed to address this knowledge gap by documenting the enablers and barriers to implementing sport for development programmes, which are inclusive of people with disabilities, and to explore the perceived impact of these programmes on the lives of people with disabilities in the Pacific.
The approach of the research was participatory and inclusive with two local Disabled People’s Organisation (DPO)* members trained and supported to be Research Assistants (RAs). The research was implemented in Australia, Suva and surrounding communities in Fiji, Port Moresby (Papua New Guinea (PNG)), and Apia (Samoa). Fieldwork conducted in Australia included interviews with ASOP stakeholders living in and outside of Australia, including one interview with a key informant living in New Zealand who managed ASOP activities across the Pacific. All other fieldwork sites were selected purposively based on consideration of where ASOP activities were implemented, its geographical accessibility, and any available resources. Data collection took place between March and May in 2015. Qualitative data was collected via key informant interviews, in-depth interviews and one focus group discussion (FGD). Wherever possible, the research team aimed to include a representative sample across gender, location, types of impairment and people representing or engaged in a range of sport for development activities.
A total of 60 participants were interviewed from the five countries (Table 1). Key informants were identified and purposively sampled in consultation with the ASC and partner DPOs. Subsequent snowballing whereby participants informed researchers of other potential participants also helped to identify additional participants. Key informants included current and former ASC staff and stakeholders (e.g. coaches and sport for development staff, as opposed to participants in sport for development activities) knowledgeable on the development and implementation of programmes that received funding through ASOP. Purposive sampling was used to recruit participants for the in-depth interviews (participants of sport for development activities), identified through the networks of partner DPOs and implementers of the sports programmes. Fourteen in-depth interviews were conducted with current participants of sport for development programmes (both male and female, with and without disabilities); four people with disabilities who had dropped out of sport; and three with parents of children with disabilities currently participating in sport. The age range of the adult participants was 24-56 years. The age range of the children with disabilities whose parents were interviewed as proxies was 9-12 years.
All participants were asked to participate in either a key informant interview (KII), in-depth interview (IDI) or a FGD. The content of the interview guides was developed based on sport for development and disability inclusion literature alongside available ASOP documentation. The focus of the KII’s included understanding of disability inclusion, experience in implementing sport for development programmes; perceived enablers of and barriers to inclusion; and perceived impact of sport on the lives of people with disabilities. The focus of the IDI and FGD included experiences of participation; motivation for participation; experience of enablers and barriers; and the perceived impact of sport for development programmes on their lives and the lives of other people with disabilities, such as access to education, employment, and community participation. Where required, interview guides were translated into the local language and back translated into English. All guides were piloted locally before being administered to participants.
Most interviews were conducted face-to-face, via telephone or skype and were digitally recorded, transcribed, and translated into English (where required) for qualitative data analysis. One key informant was not available for interview and therefore responded via email. Except in PNG, all interviews with key informants were conducted in English. In PNG, the interviews and FGD were conducted in Pidgin. As mentioned above, key informants were stakeholders considered to have knowledge on the development and implementation of ASOP activities, whereas in-depth interview participants were current or previous participants of sport for development activities. Due to limited time for fieldwork in PNG however, the FGD included both key informants and participants of sport for development activities because this was the most feasible option to collect data from these participants who had travelled to Port Moresby for a related meeting.
Data were manually coded inductively and deductively to generate themes using thematic content analysis approach. The ‘Development-through-Sport’ Strategy’s ‘theory of change framework’ for outcome two was used as the theoretical framework for the analysis (see Fig 1). The two lead members of the research team independently read all transcripts, familiarised and coded the findings while other team members reviewed a representative sample of the transcripts and coded analysis. Findings were initially coded under the relevant intermediate outcomes and pathways outlined in the ‘theory of change’ framework, including examples of enablers and barriers relevant to each pathway. Findings under each pathway were further categorised into relevant subthemes. An analysis workshop was conducted by the Australian-based research team.
Initial findings were then shared with the local RAs and other DPO and ASC staff involved in the research to ensure the analysis gave an accurate reflection of the context, and then the analysis was finalised. For the purpose of this paper, the findings have been presented under three main sections 1) Improvements in the quality of life of people with disability; 2) Barriers to inclusion in sport for development activities; and 3) Enablers of inclusion in sport for development activities.
The Human Research Ethics Committee (HREC) at the University of Melbourne in Australia approved the research. In addition, the Ministry of Youth and Sports in Fiji approved the research. The interviewers informed potential participants of the research and invited them to participate. All participants were 18 years or older and provided written or verbal consent. In cases where parents of children with disabilities were interviewed as proxies, consent was obtained from the parents only.
Improvements in the quality of life of people with disabilities
Improved Self-worth and Empowerment
All except one participant with a disability interviewed and clearly indicated that participation in sport led to a greater sense of self-worth and empowerment to create change in their lives, as highlighted by a male sport-for-development participant with physical disability in Fiji – ”[Sport] expose[s] that disabled people have talent. We can compete … I’ve noticed it gives you more confidence to expose yourself. No longer staying at home and being quiet.” Sport was also reported to contribute to social inclusion, improved access to employment and better attitudes towards people with disabilities. Participants reflected on these inherent qualities of sport, particularly highlighting that sport enabled them to challenge negative beliefs about their capabilities by providing opportunities to demonstrate their skills and talents to the broader community.
It changed my mindset. It changed how I look at myself, because I was achieving a lot. Participating in the Games … and also overseas. Being involved in the community, being on TV. It’s normal hey, because then they don’t see my disability anymore. Those are the changes that it has brought into my life. (Male sport participant with physical disability, Fiji)
The sense of empowerment and inclusion gained through participation in sport was reported to prompt participants to encourage others with disabilities to access sport. Being included alongside people with and without disabilities, and pushing each other to improve also promoted empowerment and inclusion. A male participant from Fiji who is Deaf said, “because I realised that your life could change when you started to interact more with hearing people.” This was triangulated in the findings by other participants who specifically reported feeling encouraged to participate in sport by their peers with disabilities.
The empowerment gained through sport was reported to be a driver for people with disabilities to address barriers to inclusion in other aspects of their lives, and the lives of other people with disabilities. For example, one former athlete who attributed his opportunity to participate in sport as leading to other opportunities in life such as employment, reported a sense of responsibility to address barriers to employment for other people with disabilities.
I think that for some of us who are former athletes … they tend to be engaged in other activities in the community such as becoming a businessman and sometimes have jobs such as being a cook or working in an office. As [former athletes] are aware of the problems we tend to face, and through sports, are empowered to work through these problems. It then becomes important for them to drive changes in the community, due to individual experiences of overcoming challenges. (DPO representative, PNG)
Improved health and well-being
Similarly, the majority of participants with disabilities who interviewed about their experience in sport reported that sport contributed to improved health outcomes and better self-management of health. “The Zumba programme – it actually reduces my level of stress,” commented a female participant with psychosocial disability in Fiji. It also helped people make healthier lifestyle choices.
Before I did sports, I used to smoke and drink … go clubbing. When I joined the sports, the para sports, it changed me. Right now I don’t drink grog (kava) and I don’t smoke, I do full-time training … Some of us with disability they can’t exercise themselves … they don’t reach the age they want to reach – they die early – because they don’t do exercise … I think sports is good for us … (Male sport participant with physical disability, Fiji)
Sport provided the prospect of enhanced enjoyment of life. A small number of respondents described the enjoyment of winning as greater for people with disabilities because they have had less opportunity to experience such emotions in their day-to-day life. This was also reflected in the observations of sports organisation staff.
… I can see that they’ve built up a lot of self-esteem, a lot more confidence. This is all the mental part of the person. I could see changes in themselves – being able to interact more with people and not be too concerned about what people think about their disabilities. I think they are more focused on what their abilities are rather than what their disabilities are. (National sports organisation representative, Fiji)
The social aspects of sport were ranked as more important than the competitive aspects by more than seventy percent of interviewees with disabilities. For those who participated in sport before acquiring impairment, the reason for participation often changed from the desire for personal achievement to sport’s social aspects after the impairment had occurred. People without disabilities also valued the opportunity to spend time with people with disabilities.
It was the first time for me to participate in sports with persons with disabilities and I really like it, it was a totally new experience for me. (Male sports participant without disability, Fiji)
There were also examples where organisations included social aspects for people with and without disability into their programmes, adapting activities to include an element of fun and time for socializing.
… technique disguised as a fun exercise, and they need time to socialise so with a one hour training session there should be at least five minutes or ten minutes for people just to talk to each other’ (International sports organisation representative, Australia).
Where participants had experience of representing their country in national or international events and received media attention, they described the experience of becoming ‘famous’ in their community and associated positive interaction with others. Travelling for sport within their country and internationally supported further social opportunities.
It’s fun, you meet new people and travel around … you are being exposed to other customs and traditions – you’re not closed up, you can open up … you are more confident with speaking to other people … apart from your own race and apart from Fijian people. (Male sport participant with physical disability, Fiji)
Sports programmes in schools were identified by nearly half of the DPO representatives as particularly important for children with disabilities to socialise and develop skills. A DPO representative from Samoa stated, ”What we are seeing in those kind of games we play locally … most of the kids they don’t know each other – when they come and play games they finally make friends with other kids.”This sentiment was echoed by all parents interviewed.
It has especially [impacted] social inclusiveness and access to education. Without sports sometimes, she is always idle, but with sport she is learning process, because more children they tend to learn through sports, and some of them they don’t adapt in the classroom. When you get them to play sports that’s when they learn to get engaged. (Parent of child with disability participating in sport, Fiji)
Nearly half of the interviewees with disabilities in Fiji and PNG reported opportunities for employment gained through sport. These roles included sports advocates within DPOs, sport development officers in sports organisations, and as coaches. This not only promoted economic empowerment of people with disabilities but was reported to help demonstrate their capacity to be gainfully employed, again raising their status in society.
I have even been told myself ‘’if you can do that [participate in sport] you can work in an office or go back to your normal job” or something … anything can happen. (Female sports participant, Fiji)
Opportunities to facilitate workshops and learn coaching skills through ASOP enabled some participants to build their skills in communication, which opened up doors to the workforce. Mainstream programmes that were inclusive were seen as particularly beneficial because they allowed for interaction between people with and without disabilities. A male sport participant with a physical disability in Fiji reported that “… it is an eye-opener to me because I meet plenty and more friends, especially people with disability and also people, able person, we make friends a lot and we socialise a lot.”
Community Attitudes Towards Disability
The vast majority of all research participants highlighted the ability of sport to improve social inclusion of people with disabilities, especially when implementers and DPOs were able to go into communities and raise awareness of the rights of people with disabilities. Raising awareness and understanding among the community enabled, often for the first time, people with disabilities to participate in sport activities conducted as part of these outreach visits. DPOs involved in outreach activities reported using this role to better advocate for inclusion in the broader community. One interviewee highlighted the DPO role in broader advocacy, but also how much more needs to be done.
There was one guy, who was in a wheelchair, but his home was inaccessible, it had steps and everything, so someone had to carry him down and put him in a wheelchair and then he could go out. On Sundays, he would get up, dress up, and listen to a church service from his window. We told his parents and the church about accessibility, but it costs money. Often issues with accessibility need money to fix, and the family might not be willing to spend money on that, or just can’t afford it. (DPO representative, Fiji)
Another positive example of the ASOP highlighted were activities where families are actively encouraged to allow children with disabilities to play sports, which then led to improved parental expectations of their child’s capabilities. Families reported being more hopeful about what their children can achieve, which may then encourage families to support their children to participate in other areas of the community such as cultural events, education and employment.
We [have] seen some of the parents like to play with the kids during the sports. So from there we know that parents not only to be there to look after the kids but you know that they have their heart to encourage their kids to play and have time with other kids. (DPO representative, Samoa)
Barriers to Inclusion in Sport for Development
Participants with disabilities reflected on a number of personal and external factors that impact their participation in sports. People with disabilities highlighted they often lack confidence in their own abilities, particularly when their families lack confidence in them and actively discourage their participation. Many of the interviewees with disabilities cited their families’ lack of support as a major barrier to participation. Two-thirds of these participants also identified environmental barriers to participation such as the lack of accessible information on available programmes; inaccessible facilities and equipment; and difficulty accessing transport to get to training and events.
Prejudice and Discrimination
Three-quarters of key informants identified prejudice and discrimination as a significant barrier to the inclusion of people with disability in sports programmes. In communities where there were perceived negative attitudes toward disabilities, programme implementers reported difficulty while including people with disabilities in community-level activities, as people with disabilities were hidden within the home or families would not allow them to participate. The vital broader role of DPOs in addressing prejudice and discrimination and raising awareness of rights was again highlighted, particularly during community outreach programmes.
The longer-term impact of community outreach programmes on participation is more difficult to determine. A small number of key informants felt that as community programmes are often one-off visits, they don’t allow for enough community engagement to contribute to sustained attitudinal changes, or to develop sustainable inclusive sport programmes.
A small number of research participants with and without disabilities noted that opportunities to participate in sports are not the same for all people with disabilities. One key informant reported staff often don’t have appropriate understanding of how to interact with people who have certain disabilities, stating “If they have a physical disability they are more likely to be included, whereas people with a mental disability, there is often that fear of well ‘I don’t know how to talk to you, because you have a mental disability.” (International sports organisation representative, Australia). This perception was echoed by a small number of participants.
For my brothers and sisters who are not confident to come out in public, one of the barriers would be attitudes of people, probably the stigma. Because people … when someone has been admitted to St Giles [psychiatric hospital in Fiji] they tend to act differently to that person … (Female sport participant with psychosocial disability, Fiji)
Those with intellectual disabilities …. Because they are seen by the public differently rather than … because it’s not your physical body that’s affected. … you know you are intellectual… and immediately when people see them they will say ok we cannot play with them because you know whatever we plan, it will turn up differently because of them … (DPO representative, Samoa)
For women with disabilities, there was a sense of disparity expressed when describing efforts to participate in sport, with one saying that “when I trained I am the only girl for, I think, four months, and for me there is gender imbalance there.” (Female sport participant with vision impairment, Fiji). Some participants with and without disabilities also identified that females with disabilities may face additional discrimination.
… sometimes it’s the women who are being laughed at mostly I’ve heard of that … I’m thinking why do they do that to that particular person – why is it a woman who has to be the one who go through a lot of things that make her feel she is not wanted? (Female sport participant with physical disability, Fiji)
Lack of Family Support
An absence of family support or active discouragement was identified as a common barrier by nearly half of the participants with disabilities who interviewed. Many reported strong cultural and traditional beliefs, particularly in the rural areas, whereby families believe people with disabilities should stay at home. A small number of key informants emphasised the importance of addressing these barriers and encouraging families to enable family members with disability to participate in sport.
… [they say] ‘no my child did not play that game because you know he has a disability, he can’t play.’ So they come and just say that, you know, take away kids from the event … we have to provide some awareness programme … to encourage the parents to bring in their kids … because most of the parents here in Samoa believe that people with disability [should] just stay home. (DPO representative, Samoa)
Limited Accessibility of Sport-for-Development Programmes
Inaccessible sporting facilities and lack of knowledge on how to make reasonable accommodations* to support inclusion were seen as an ongoing barrier to participation by more than half of all research participants. People with disabilities highlighted that they wanted access to more choices in programmes and that programmes should sustain interest by allowing for increased challenges. This is particularly important when considering the involvement of people with more complex participation requirements. It was expressed that some sports currently only cater to people who are more mobile and use common communications methods with people who have more complex physical or cognitive needs missing out. A few key informants reported that genuine commitment, time and resources are required from organisations to analyse and solve problems surrounding how their sport can be modified to enable people with different abilities and impairments to participate.
For some participants with disabilities who live relatively close to urban areas, significant motivation and financial resources were still required to commit to training. Even where physically accessible buildings do exist, access was reported to be constrained by short opening hours of venues; difficulty getting to the venue; and difficulty mobilising within the venue around equipment.
We have a gymnasium whereas in the day but it’s always full. It’s a small gym and a lot of corporate bodies training … [it’s] hard for me. And they only open at about 3 o’clock in the afternoon. So in my case if someone is to open a gym close to where I am they should open in the morning so when abled people go to work. (Male sport participant with vision impairment, Fiji)
Access to sport was reported to be better in urban cities compared to rural areas. A small number of interview participants from Fiji reported that sporting venues in the country’s capital had improved in terms of accessibility, but in communities outside the city, accessibility was an ongoing issue. In PNG, half of the participants with disabilities described travelling from rural areas to attend a sport event only to find a lack of modified equipment had been provided by the programme, thereby not allowing everyone to participate. Similarly, limited access to coaches in rural areas was reported to prevent participation.
Lack of Information About Sport
Two-thirds of participants with disabilities in Fiji cited limited access to information about sport-for-development activities as a reason people with disabilities are not participating. Factors impacting access included a lack of information in accessible formats. One participant suggested that the events “should have more advertising in the media through TV or print … so people with disabilities can read and know that this is happening … because [people with disabilities] isolate themselves and don’t know what’s happening.” (Female sport participant with psychosocial disability, Fiji). Conversely, effective collaboration between sports organisations and DPOs was said to support better access to information on upcoming events. This was reported as essential for people with disability so they have time to prepare and organise assistance to participate if required.
At the moment this coordination and consultation is lacking … us DPOs we do not have [opportunity to be consulted during planning]…. (DPO representative, PNG)
Lack of Accessible Public Transport
All participants with disabilities cited transport as one of the most significant barriers to participation and for some, it was the primary reason for dropping out of sport. Constraints to accessing transport were described in three ways: limited finances to support transport needs; real and perceived discrimination experienced by people with disability attempting to use public transport; and lack of physically accessible transport. Some organisations recognised this barrier and provided transport for ‘come and try’ sport days. Others are starting to make adjustments to the way they deliver sport, stating, “We are trying to alleviate that problem by taking the sport to them rather than asking them to come to us by using outreach programmes.” (Sport organisation representative, Fiji). However, neither of these approaches solves the ongoing issue of inaccessible transport, highlighting the need to support governments to address systemic barriers to inclusion of people with disabilities in society.
Many people with disabilities in Fiji have access to free public transportation, yet this doesn’t address all the barriers they face to accessing transportation. Three participants with disability reported that despite having a free bus pass, some bus drivers would prevent them from getting on the bus during peak periods, reporting that they had time restrictions and couldn’t provide extra time for a person with a disability to climb into the bus. The latter issue arose because buses are not wheelchair accessible and so in some cases people would crawl onto the bus and ask a bystander to fold and lift their chair onto the bus for them. One of these participants went onto discuss that prejudice and discrimination, both real and perceived, prevented people from accessing public transportation even when their impairment physically did not.
Lack of Options and Competitive Pathways
Moving beyond engagement in social sport activities to more competitive activities can be very challenging for athletes. Whilst many people with disabilities interviewed were motivated to play sports for health and social benefits, there were others who were frustrated by the barriers to more competitive pathways. In PNG, for example, a lack of options was attributed to a lack of people with disabilities holding leadership positions in sports organisations; inadequate engagement of people with disabilities in the design and implementation of sports programmes; and a lack of collaboration between service providers and DPOs, particularly when service providers have ‘control’ over the implementation of sport for development activities. Also highlighted was the need for more recognition of the achievements of athletes with disabilities and better support for these athletes to achieve at a higher level. One DPO representative in PNG reported, “I won three gold medals in the PNG Games, the javelin, shot-put and discus … I also participated in the Arafura Games … however from then on I was not supported to progress on to the next level.” (DPO representative, PNG)
Disability-specific Barriers Which Impact on Participation
People with disabilities often experience disability-specific barriers that impact their participation in sport. Approximately half of the interview participants with disabilities in Fiji reported experiencing disability-specific barriers during their engagement in sport for development programmes. These include communication barriers for people who are deaf or hard of hearing in accessing a programme delivered by people who do not communicate using sign language and without an interpreter. Or lack of assistive devices, such a prosthetic limbs or appropriate wheelchairs that would support people with mobility impairments to engage in sport. There were examples of organisations trying to overcome this, such as in Suva, whereby some sports officers were learning sign language to enable them to engage with people who are deaf. Yet this hasn’t happened in most areas in Fiji or other Pacific countries, highlighting how opportunities can differ for people with the same impairment, depending on the resources available in their environment and the efforts that have been made to include them.
For years there has been a Deaf Table Tennis club [in Fiji] and this has been integrated completely. There are deaf coaches who coach able-bodied players and yet they don’t see the disability at all. But in Vanuatu being deaf is very much more difficult because not many people speak sign language. (International sports organisation representative, Australia)
In most Pacific countries, access to assistive devices and alternative communication modes is an area that tends to lie outside of the domain of sport, yet it directly influences how and how well people with disabilities are able to participate in sport. A lack of access to quality and fit for purpose assistive devices was another issue raised by a small number of participants with disabilities, particularly those wanting to compete at an international level. Even at the community level, access to affordable replacements for damaged walking aids was identified as placing further burden on the limited finances of people with disabilities that impacted their participation. Similarly, people with disability reported a lack of assistance at training such as ‘guide runners’ and support getting in and out of the pool. These issues were all described as reasons for dropping out of sport.
Need for Greater Monitoring and Evaluation
Implementers discussed the requirements of the PSP programme to include reporting on numbers of people with disability who are accessing programmes. ASC were encouraging implementers to use the Washington Group Short Set* of questions to support this and fill a current gap in the programmes to identify people with disability. Better identification of people with disabilities to support inclusion was also highlighted by DPO representatives.
There were also some good examples of sport organisations seeking to measure attitudinal change toward disability within their monitoring and evaluation systems and collecting stories of change from participants about the impact of the programmes. Overall however, this research identified a tension between a growing need for better data collection on inclusion and the capacity of local sports implementers to collect and report this data.
Many of the international sport organisation representatives interviewed reported finding it challenging to build the capacity of local implementers to collect basic data on the numbers of people with disabilities participating in programmes, let alone trying to document changes at the community level.
Enablers of Inclusion in Sport for Development Activities
A number of factors that facilitate inclusion in sport emerged, including peer-to-peer encouragement, support from DPOs and sports organisations, and meaningful participation of people with disabilities in all aspects of sports programmes.
Peer-to-peer Encouragement and Role Modelling
Encouragement from peers with disabilities also engaged in sport was described as a major facilitator of participation and initial entry point into sport by many of the participants with disabilities interviewed. Such examples serve as evidence of this peer-to-peer pathway being built into some programmes more formally. In Fiji, for example, DPOs helped identify ‘Sports Champs’ to be role models and help identify and encourage other people with disabilities to participate in sport.
This concept of role models promoting participation in sport was a strong theme emerging throughout the research. Most respondents in Fiji, for example, reported the achievements of the Honourable Assistant Minister Iliesa Delana (a Fijian athlete with disability) at the London Paralympics, who went on to be elected to the Fijian parliament as a turning-point in changing the perceptions people with disabilities had of themselves, as well as challenging how the community perceived people with disabilities.
People with Disability in Leadership
Beyond participating in sport itself, a number of participants described pathways that enabled them to engage in sport in positions of leadership. Having more people with disabilities in positions of leadership was described as a way to make people with disabilities feel more comfortable about joining programmes. One female sport participant with a vision impairment in Fiji said, “While I was training for my athletics we used to have a coach who was also disabled so he used to understand us.” Some respondents also identified that involvement of DPO representatives in programmes had led to people with disabilities taking on leadership roles within their community in Fiji, such as the Toragi ni koro. (Chief Liaison at the village level)
Inclusion of People with Disability in All Aspects of Programmes
Meaningful participation in sport for people with disabilities goes beyond being a beneficiary of sport activities. It also encompasses inclusion in sport processes, including planning, implementation, monitoring and evaluation of programmes. The inclusion of people with disabilities in the planning of programmes was recognised by many key informants as contributing to better understanding about the capacity of people with disabilities to participate in sports programmes, and the development of more accessible and inclusive programmes.
So that’s what I call inclusive sport … you design something that includes everyone’s idea and make sure that everyone is involved from the beginning, the implementation and monitoring and evaluation as well as reporting … you don’t just ask [people with disability] to join when the programme is half way through. (DPO representative, Samoa)
A key enabler to supporting inclusion in all aspects of programmes highlighted was providing more opportunities for networks to share good practice and facilitate cross-organisational learning. Sports organisations vary greatly in how they implement disability inclusion. By showcasing examples of good practice, it is hoped all organisations would be encouraged to improve inclusion within their programmes and promote more opportunities for people with disability to engage in all aspects of sports programming.
Encouragement and Support through DPOs, Sport Organisations and Family
DPOs and sports organisations were highlighted as playing an important role in encouraging participation in sport. Individuals within these organisations were reported as being instrumental in identifying people with disabilities in communities and nurturing their skills and talents. People with disabilities were reported to sometimes be “locked at home.” Participants acknowledged that because of this and the long history of exclusion of many people with disabilities, significant time and effort is often required to encourage individuals with disabilities to participate.
Like, they still feel shy. There is still that stigma, that barrier that they have. So we sports people, sometimes we have to go that extra mile, we have to break the ice with them in order to get them to open up and be comfortable. (National sport organisation representative, Fiji)
Individuals with an understanding of and interest in inclusion were recognised for their role in championing inclusion while also encouraging and linking in a number of individuals with disabilities into sport networks. These individuals included coaches, mentors and other sports leaders who identified participants and supported their inclusion through encouraging family support, securing funding, training people with disabilities to be coaches, and encouraging networking between DPOs and mainstream sports organisations.
I think what has worked well in some countries such as Fiji and Vanuatu is that there has been a champion who has actively sought out how to include people with disability … in Australia when we talk about those champions it’s often people who have had a family member with a disability. That doesn’t seem to be the common denominator in Vanuatu and Fiji. It’s just that these people have got a really good awareness about disability and an attitude towards inclusion … (ASC representative, Australia)
Social marketing campaigns were seen as an important tool for inclusion through their use in highlighting the success of athletes with disabilities and motivating people with disabilities to participate in sport. Organisations are also starting to explore ways they can engage with social marketing to support participation, both in terms of promoting media coverage of people with disability in sport, and utilising technology to promote participation. A representative from an organisation noted, “I think mainly we use media and word-of-mouth. Right now, we’re hoping to use text messages on phones and various other marketing mechanisms we have, such as TV.” (National sports organisation representative, Fiji).
Many participants with disability reported that when family support was available, it was integral to their ongoing participation. Different kinds of family support were described, such as practical support like helping people get to training or helping finance the cost of participation. Families were also central to enhancing the self-belief of their family members with a disability which in turn enabled participation.
My family embraced it – even when they saw [disability] happening to me they still kept encouraging me … I didn’t want to listen – I was too ashamed to go around. (Male sport participant with physical disability, Fiji)
Opportunities to Participate in Mainstream Sport Programmes
Providing opportunities for people with and without disabilities to play sport alongside each other is an important approach to inclusion, which was highlighted by nearly half of all research participants. Some organisations implemented this approach, but not all. The findings also suggest that people with disabilities often participate in mainstream sport due to self-motivation, rather than an as a result of opportunities provided by sports organisations.
Schools, particularly schools for children with disability and colloquially referred to as special schools were regularly cited by participants with disabilities and key informants as a common entry point for children with disabilities into sport. Sport for development activities implemented in special schools allowed for development of skills in a safe and supported environment, which for some children with disabilities can support transition into mainstream sport activities.
Yet programmes implemented in special schools were also mentioned as actually creating barriers as they keep children with disabilities segregated from playing sport with children without disabilities. The need to develop the capacity of sports organisations to design and implement more programmes outside of disability-specific settings was highlighted by some implementers. There is evidence this is starting to occur, with some sports organisations implementing programmes outside of school hours which are inclusive of children with and without disabilities.
… what we are seeing in those kind of games we play locally … most of the kids they don’t know each other when they come and play games they finally make friends with other kids. (DPO representative, Samoa)
Findings from this research support evidence in the literature that sport can be a powerful transformative tool, improving the overall status of people with disabilities within society.6,19Promoting access to sport for people with disabilities has the capacity to improve the quality of life of people with disabilities, and improving physical and mental health particularly in the context of increased incidence of NCDs.11,13,14 More importantly, in line with previous research, to enable people with disabilities to reduce the emotional effects of disabilities by offering a way to accept their disability (“come out”) and to manage the discriminatory effects of disabilities.20
By providing a platform for people with and without disabilities to come together, there is an opportunity to challenge commonly held misconceptions about disabilities and for people with disabilities to demonstrate their capacities. It also provides an opportunity for people without disabilities to interact and socialise with people with disabilities. This may help to address negative attitudes towards disabilities, a major barrier to the inclusion in other activities such as education, employment and community participation more broadly.1,2
Realising the rights of people with disabilities to participate in sport requires governments and sport for development programmes to clearly articulate disability inclusion in their strategies, contractual agreements, implementation plans, and as part of their monitoring and evaluation. A strong policy environment for health and physical activity is vital,14 making sure relevant policies are disability-inclusive would strengthen subsequent inclusion within implementation. Increasing participation of people with disabilities in sport will also require collaboration with stakeholders outside the sport sector, for example the corporate sector, transport authorities, health and rehabilitation, and urban planning. Sustainability and effectiveness of sport for development programmes relies on appropriate human, technical and financial resources.9 Dedication of resources to embed disability inclusion in sport-for-development activities and these related sectors over time will require ongoing commitment from donors and implementing partners.
Effective and sustainable sport for development programmes require leadership and collaboration.9 The same is required of disability-inclusive sport for development programmes. The research highlighted a number of important networks and partnerships that support inclusion of people with disability in sport. Central to these are the partnerships between DPOs, national sports organisations, and their international or regional counterparts. People with disabilities are the key stakeholders in sport for inclusive development networks. In recognition of this, programmes should determine appropriate mechanisms and adequate resources to ensure people with disabilities can provide leadership and coordination of these networks, support organisational commitment and capacity for disability inclusion, and meaningfully engage in all aspects of programming.
Strong leadership is required from all stakeholders to provide more opportunities for people with disabilities who are currently less likely to have access to programmes such as women,13,14 people with psychosocial disabilities, intellectual disabilities, and those with more complex participation requirements. This could be achieved by building on international examples of modified sports, and collaboratively problem-solving with DPOs to enable people with more complex impairments to participate.
Inclusion of people with disabilities in programmes not only benefits individuals, but their families and the broader community.10 Implementers of programmes and DPOs need to continue to work with families and communities to raise awareness of disabilities, and promote an understanding of the benefits of sport including the potential to promote access to other life domains such as social inclusion, education and employment. Similar to other findings in the literature, this study found that drawing on high profile role models and ‘champions’ is key to promoting awareness and encouraging participation in sport of individuals who are more likely to have experienced exclusion and marginalisation.15
People with disabilities want more choice and options as to how they participate in sport – from intermittent social participation, to participating at an elite level, and engaging in sport beyond playing, in roles such as coaching. Similarly, as many people with disabilities living in the Pacific do not live in urban areas where many sports programmes are implemented, organisations need to continue to build their capacity to provide more opportunities for people with disabilities to participate in sport in rural and remote areas. Building on community outreach programmes and collaborations between DPOs, sports organisations and rural communities is one way this could be achieved.
With the growing recognition and utilisation of sport as a tool for development, continual sharing of experiences of how sport for development can be inclusive of people with disabilities could encourage development actors using sport to better include people with disabilities.7 It is also positive to see a move towards collecting data, for example, through the use of the Washington Group questions, to better understand the rate of participation of people with disabilities in programmes. Yet, to evaluate the longer-term impact of inclusive sports programmes on reducing negative attitudes and promoting inclusion in the broader community, and to address the need to build the evidence base on the effectiveness of sport for development to promote the rights of population groups more likely to be excluded from development, counting the numbers of people with disability participating in programmes is insufficient.17,21,22
The need for improved quality of research on the impacts of sport-for-development is gaining recognition.9,21,23 Attributing the specific impact of inclusive sport-for-development programmes and the sustainability of this impact, requires a deeper understanding of the contextual factors which influence inclusion within sport and broader community domains including development programming. There would be great benefit in conducting baseline studies in communities before implementing programmes and disaggregating data by disability in order to really understand the current experience of people with disabilities as compared to people without disabilities; how this impacts on their access and participation in sport and other areas of community life; and what barriers need to be addressed to improve inclusion, including attitudinal barriers.24
This could then be followed up with an evaluation of the programme using the same survey to allow for an analysis of the longer-term impact of the programme for people with disabilities in their communities. Combined with other monitoring and evaluation techniques such as collection of qualitative data through stories of change, this would also enhance global understanding about how sport can be used more broadly as a tool in development.17 Guaranteeing these processes are embedded in programmes requires funders to ensure that the terms of references for implementers include appropriate resourcing for disability inclusion and its monitoring, evaluation and learning through research.
LIMITATIONS OF THE RESEARCH
The research was conducted in a tight timeframe with limited resources. As such, despite efforts made to ensure people with different types of impairments were included in the sample, it was difficult to ensure adequate representation of all groups. In particular, we were unable to directly interview people with intellectual disabilities. Given more time and resources, it would also have been beneficial to directly interview children with disabilities about their experiences in sport. The decision to use proxies for children with disabilities was made with the knowledge that limited time in-country would make it difficult to develop and use appropriate participatory methods, which would have allowed for children to directly participate in the research. More time in the country would also have allowed us to collect more information from people with disabilities living in rural and remote areas.
Because a purposeful sampling method was used, there may have been a selection bias towards people known to have positively participated in sport. Interviews were conducted with people who have dropped out of sport to try and counteract this effect. Whilst this research collected in-depth qualitative data from a range of participants, both with and without disabilities, collecting data at one point in time doesn’t necessarily provide data about changes in participation in the community over time. Nor does it allow an accurate measure of change of attitudes and barriers to participation in the community. The use of baseline surveys and ongoing monitoring and evaluation would help researchers overcome this issue.
Disability inclusion is reaching a critical point whereby organisations are becoming more aware of the importance of inclusion. There have been significant positive changes since the introduction of the CRPD, which are reflected in this research. It is hoped that this trend will continue the explicit inclusion of disability within five of the SDGs. The growing recognition of the effectiveness of sport as a tool for development, including in the SDGs, and the importance of disability-inclusive development provides an excellent opportunity to advocate for the implementation of sport-for-development programmes which are inclusive of people with disability.6 Ensuring people with disability are included within sport-for-development programmes will contribute to the improved quality of life of people with disabilities, and help fulfil the development community’s responsibility to ensure people with disabilities are no longer marginalised from the processes and benefits of broader development goals.
CBM-Nossal Partnership for Disability Inclusive Development led the research, supported by two DPO members from the Fiji Disabled Peoples Federation who were trained and supported to be Research Assistants.
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