Outdoor play decisions by caregivers of children with disabilities: A systematic review of qualitative studies

Outdoor play offers children vast benefits for development and well-being. However, children with developmental disabilities participate less in outdoor play than their typical peers. Typically, adults make decisions about children’s play routines, especially for children with developmental disabilities. The purpose of this systematic review was to synthesize the results from qualitative studies on decision making processes of caregivers around outdoor play in children with developmental disabilities using ecocultural theory. Studies addressing decision making of parents, teachers, and other caregivers of primary school-aged children with developmental disabilities relating to outdoor play were searched in CINHAL, Medline, Web of Science, ERIC, Scopus, PsycINFO, and SocINDEX from 1990 to May 2015. Eleven predominately qualitative studies met the inclusion criteria. The CASP quality of reporting quality checklist was used to evaluate the transparency of reporting for included studies. An ecocultural framework was used for thematic analysis and synthesis. Results showed caregivers, families, schools, and communities consider many factors when deciding about when, where, how, and if outdoor play occurs. Factors comprised: motivation for participation in outdoor play; social and built environments; familial and school considerations including time and finances; caregivers’ awareness of opportunities; and child considerations such as their skills, health, and interests. A dynamic interaction exists between and within the ecocultural environment of a child with developmental disabilities to determine decision outcomes in outdoor play. Consequently, to increase the opportunities for benefits associated with outdoor play, each ecocultural layer must be targeted.