Chapter 4 - Participation restrictions

• Adults with impairment at both waves and onset-acquired adults were more likely to report participation restrictions at both Wave One and Wave Three in nearly all life areas covered by the survey

• The majority of adults faced a participation restriction to leisure, more so than any other life area. This was regardless of impairment status

• Adults with impairment at both waves and onset-acquired adults reported that a health condition, illness or impairment was a barrier to participation in the life areas of leisure and social contact

• The majority of adults felt they had choice over how they spend their free time, regardless of impairment status

• Adults with impairment at both waves were more likely to report having little or no choice over how they spend their free time than other groups

• Having a health condition, illness or impairment was the top barrier to playing sport for adults with impairment at both waves

• Having a health condition, illness or impairment was also a barrier to playing sport for adults without impairments at both waves

This chapter explores how participation restriction was experienced by adults in different areas of their life, and whether there were changes to their experience of restriction between Wave One and Wave Three¹.

The LOS collected information about adults’ participation restriction in 8 different life areas:

• education and training

• work

• economic life (ability to pay household bills)

• transport

• leisure activities

• social contact

• accessibility in the home

• accessibility outside the home

An adult has a participation restriction in a life area if he or she experiences at least 1 barrier in that area. This chapter will provide an overview across life areas and will then focus on participation restriction at Wave Three to leisure activities, with a particular focus on sport.

Comparisons are made between the 4 analysis groups described in Chapter 2:

1. adults with impairment at both waves

2. offset adults

3. onset-acquired adults

4. adults without impairment at both waves

These groups reflect the diversity of impairment status, in that impairment status may be stable, or may change over time. A person may have impairments at both waves (group 1) or no impairment at both waves (group 4), or they may no longer have impairments (group 2) or they acquire impairments at Wave Three (group 3).

Notes for 4.2 Aims of the chapter

1. Wave One interviewing took place between June 2009 and March 2011, while Wave Three interviews occurred between October 2012 and September 2014

This section considers changes in participation restrictions adults have experienced between Wave One and Wave Three.

As found in an earlier LOS report, there appears to be an association between impairment and participation restriction. This can be seen in Table 4.1, where almost 40% of onset-acquired adults – those with impairment at Wave Three but not at Wave One – experienced an increase in the number of life areas where they faced a participation restriction. This was a higher percentage than any other group, although the difference between the onset-acquired group and the impaired at both waves group was not statistically significant. In contrast, offset adults – those with impairment at Wave One but not at Wave Three – were more likely to report a decrease in participation restriction than other groups.

Adults with impairment at both waves were more likely than adults without impairment at both waves to report an increase in the number of life areas where they faced a participation restriction. However, they were just as likely to report a decrease as an increase. This would perhaps indicate there has been no systematic change in restrictions adults face to participation in life areas and highlights the diversity of experience of these groups. The picture may be different when individual life areas are considered. This is explored in section 4.4.

The likely association between impairment and participation restriction appears to hold for the majority of life areas. Adults with impairment at both waves were more likely than adults without impairment at both waves to report a participation restriction in all the life areas considered on the LOS. This was true at both Wave One and Wave Three, as shown in Figure 4.1 and Figure 4.4, although the difference for "Social Contact" at Wave Three was not statistically significant. This likely association is also reflected in Figures 4.2 and 4.3.

Offset adults were more likely to report a participation restriction in each of the life areas in Wave One – when they reported having impairment – than they were in Wave Three (Figure 4.2). For onset-acquired adults, a higher percentage experienced a participation restriction at Wave Three than at Wave One (Figure 4.3), although the differences were not statistically significant. The smaller numbers of onset-acquired and offset adults in the LOS may be having an influence, as it is more difficult to identify statistically significant differences with smaller sample sizes.

Leisure remained the life area in which most adults experienced a participation restriction, regardless of impairment status.

We saw in Section 4.4 that the majority of adults faced a participation restriction to leisure. Previous research has found that disabled people value choice over leisure activities but they often feel constrained in this area¹. The LOS asked adults how much choice they had over how they spent their free time.

The majority of adults reported some or a lot of choice in how they spend their free time. However, adults with impairment at both waves were more likely than other groups to report having little (21%) or no (5%) choice. For adults without impairment at both waves, only 9% reported little or no choice in how they spend their free time.

Section 4.6 explores the different areas of leisure where adults faced a participation restriction and the barriers they faced.

Notes for 4.5 Choice in how free time is spent

1. Rabiee, P. and Glendinning, C. (2010) Choice: what, when and why? Exploring the importance of choice to disabled people, Disability & Society, 25, 7, 827-839

This section looks at adults who have reported a participation restriction in the area of leisure and explores which activities they faced a restriction to participating in. Adults were shown a list of activities relating to leisure, culture and sport and were asked whether there were any they would like to do more of but were not able to. Where adults selected more than 3 activities, they were asked to select the 3 activities that they would most like to do.

Figures 4.5 to 4.8 show that while the percentage of adults with impairment at both waves reporting a restriction to participating in leisure activities tended to be greater than for other groups, the types of leisure activities they faced restriction to were the same. This implies that having an impairment may affect participation in all areas of leisure, although this effect is likely to vary between individuals.

The top 3 areas adults would like to do more but faced a participation restriction, regardless of impairment type, were going on holiday, spending time with family and visiting friends. The most common barrier reported to going on holiday was financial¹. This did not appear to be related to impairment status, as the same percentage of adults with impairment at both waves cited this as a reason as adults without impairment at both waves – 66%. Spending time with family and visiting friends are considered further in Chapter 5, which looks at Social Contact.

The next 2 most common areas within leisure where adults would like to do more but faced a restriction to participation were going to the theatre, cinema or other arts activity and playing sport. When asked about barriers, time and money were common reasons given for not being able to participate in many of the leisure activities, including going to the theatre, cinema or other arts activities. While some adults reported time and money as barriers to participating in sport, these reasons were less common than for other leisure activities. Barriers to participating in sport are discussed in more detail in section 4.8.

The potential relationship between impairment and participation restriction is further demonstrated when considering barriers to leisure activities. Adults with impairment at Wave Three (adults with impairment at both waves and onset-acquired adults) were more likely to report a health condition, illness or impairment as a barrier to the various leisure activities covered by the LOS than those without an impairment at both waves. These differences were statistically significant for all activities, except "going to the library or archive" and "other".

The percentage of adults with impairment at Wave Three reporting a health condition, illness or impairment as a barrier to various leisure activities was also higher than for offset adults. These differences were statistically significant for going on holiday, visiting friends, spending time with family and "going to a museum", but not for other activities.

The length of time an adult has an impairment and the severity of impairment², also seem to have an effect. Adults with impairment at both waves were more likely to report a health condition, illness or impairment as a barrier to all activities in the life area of leisure than onset-acquired adults, that is, adults who had not reported impairment at Wave One. The exception was "going to the library or archive" and "other", where these differences were not statistically significant.

Notes for 4.6 Participation restrictions to leisure, culture and sport

1. See Appendix 2 for a full list of barriers to leisure activities

2. We saw in Chapter 2 that adults with impairment at both waves were more likely to report "severe" difficulty and "frequent" limitations

Adults may report barriers to participation in a life area without necessarily having tried to access any services in that area. On the LOS, adults were asked whether they had contacted, tried to contact or had any dealings with any public services within the last 12 months, including culture, sport and leisure services. Those who had were then asked what level of difficulty they had faced in accessing those services – no difficulty, some difficulty or a lot of difficulty. Overall, around 1 in 10 of those who were interviewed at Wave One and Wave Three had tried to contact culture, sports and leisure services.

The majority of adults who had tried accessing culture, sports and leisure services in both Wave One and Wave Three experienced no change in difficulty accessing these services. A greater proportion of adults with impairment at both waves saw a decrease in difficulty in accessing culture, sport and leisure services than other groups.

This section looks at the barriers to participation in sport, so focuses on adults who reported they would like to do more of this activity but faced a participation restriction to playing sport. The percentage of adults who reported a participation restriction to playing sport varied by analysis group, from 16% (offset adults) to 22% (onset adults) – see Section 4.6.

Adults with impairment at both waves who had a restriction to participating in sport were likely to report an impairment-based reason as a barrier. A health condition, illness or impairment was the top barrier for this group, followed by disability related reasons.

Although adults with impairment at both waves were more likely to give a health condition, illness or impairment as a barrier to playing sport, this reason was given by all 4 groups. This reflects the influence a health condition, illness or impairment has on participation in sport. As described in Chapter 1, adults may have a health condition but not be classified as having an impairment for the purposes of LOS. For example, an adult may have a health condition but only have reported mild difficulties relating to this condition.

Time and money were commonly given as reasons for not being able to participate in sport, and were in the top 4 barriers for all groups. However, as discussed in Section 4.6, a smaller percentage of adults said time and money were barriers to playing sport than for other leisure activities.

One of the top 4 barriers to participating in sport for both onset-acquired adults and adults without impairment at both waves was caring responsibilities. More information on caring responsibilities in relation to work can be found in Chapter 3.