Personal and environmental pathways toparticipation in young children with and withoutmild motor disabilitiescch_1295 561..571

B. Soref,* N. Z. Ratzon,* L. Rosenberg,* Y. Leitner,† T. Jarus‡ and O. Bart*

*Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University†Child Development Center Dana-DWEK Children’s Hospital, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel, and‡Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada

Accepted for publication 5 July 2011

Keywordschild and maternalself-efficacy,environmental factors,motor disability,participation,socio-economic status

Correspondence:Orit Bart, Department ofOccupational Therapy,School of HealthProfessions, SacklerFaculty of Medicine, TelAviv University, RamatAviv, Tel Aviv 69978, IsraelE-mail:o_bart@bezeqint.net

AbstractObjective Participation in everyday activities has a positive influence upon health and well-being

and is considered as an outcome measure. According to recent models child participation is the

product of the dynamic interaction between health states and both individual and environmental

factors. Children with mild developmental disabilities often present decreased participation in

everyday activities. The purpose of this study was to explore the extent to which individual and

environmental factors explain the participation of young children, with and without mild motor

disabilities.

Methods The study population included 58 kindergarten children together with their parents (29

children with mild motor disabilities who were referred to occupational therapy and 29 children

without motor disabilities). Both groups of children were matched for: age; gender; age of parents;

and socio-economic status (SES). We assessed participation using the Child Participation

Questionnaire (intensity, diversity, independence, child enjoyment and parental satisfaction) and we

assessed children’s self-efficacy and motor abilities for individual factors. Parental self-efficacy and

SES were collected by questionnaires.

Results Participation diversity (number of activities) was predicted by child and mother

self-efficacy and by SES. Child independence and enjoyment as well as parental satisfaction were

predicted by child motor ability but mainly by maternal self-efficacy. Results suggest that the total

explained variance is more than double when the environmental variables (parental self-efficacy

and SES) are inserted to the participation model.

Conclusions Maternal self-efficacy and SES serve as facilitators to increased participation and

well-being of children with mild motor disabilities.

Introduction

Many studies indicate the factors that affect the normal devel-

opment of the child however; few studies assess the factors

affecting child participation and engagement in everyday activi-

ties. The World Health Organization defines ‘participation’ as

involvement in a life situation and reflects a shift from a medical

model of disability to a broader bio-psychosocial model of

health condition (International Classification of Functioning,

Disability and Health; WHO 2001). Studies have shown the

bs_bs_banner Child: care, health and developmentOriginal Article doi:10.1111/j.1365-2214.2011.01295.x

© 2011 Blackwell Publishing Ltd 561

positive influence upon health and well-being from participa-

tion in activities of daily life. Research has revealed that partici-

pation is essential for psychological, emotional and skill

development, and contributes to both life satisfaction and a

sense of competence (Law 2002). While the updated Inter-

national Classification of Functioning, Disability and Health

(WHO 2001) defines the domains of participation (self-care,

domestic life, communication, social life, learning, etc.),

researchers have established a need to evaluate participation in

terms of intensity, level of assistance, enjoyment and satisfaction

(Law 2002; McConachie et al. 2006; Coster & Khetani 2008).

Bronfenbrenner’s socioecological approach considers children’s

development within the context of the systems and relation-

ships with their environment (Bronfenbrenner 1979). Based on

this acknowledged model, researchers point out that participa-

tion and engagement in everyday activity is dependent upon a

dynamic interaction between the child’s state of health with

both individual and environmental factors (Kielhofner 2002;

Case-Smith 2005).

Individual factors

Individual factors affecting participation include motor and

cognitive abilities as well as the way in which children perceive

and evaluate their own abilities. Studies indicated the correla-

tions between child participation and individual factors such

as: age (Brown & Gordon 1987; Henry 1998; Huston et al. 1999;

Law et al. 2006; Jarus et al. 2010); gender (Maccoby 1998; Fabes

et al. 2003; Mchale et al. 2004); motor skills (Bart et al. 2010);

emotional-cognitive abilities and health (Brown & Gordon

1987; Desha & Ziviani 2007; Engel-Yeger et al. 2008). Children

with either severe developmental disability or even mild devel-

opmental disability (MDD) show decreased participation in the

different domains (e.g. Chen & Cohn 2003; Mandich et al. 2003;

Summers et al. 2008). For example, Bar-Haim and Bart (2006)

showed that children with low motor abilities displayed a lower

frequency of social play. Case-Smith and colleagues (1998)

proved that preschool children with difficulties in fine motor

skills participate in less self-care tasks.

Among emotional-cognitive abilities child self-efficacy was

found to affect child participation and independence (Cairney

et al. 2005; Rosenberg et al. 2010b). Child self-efficacy is defined

as the child’s belief in his/her ability to complete a task (Harter

& Pike 1984; Bandura 1994). Bandura (1994) describes the

gradual manner in which child self-efficacy develops. Prelimi-

nary attempts of investigation, in which the child has the oppor-

tunity to experience the impact of his/her actions on the

environment, form the foundation for self-efficacy. According

to Missiuna and colleagues (2006) actually experiencing a task

helps young children to improve their skills and thus contrib-

utes to the development of self-efficacy perception. In addition,

the extent to which children estimate their abilities affects their

motivation, persistence and their level of participation in the

activity (Missiuna 1998; Chen & Cohn 2003; Missiuna et al.

2006).

Environmental factors

Environmental factors include: family characteristics; socio-

economic status (SES); level of income; parental level of educa-

tion and; human factors such as parental perceptions and beliefs

(Case-Smith 1995; Bianchi & Robinson 1997; Coleman &

Karraker 1997; Law 2002; Chen & Cohn 2003). Study results

confirm that among the environmental factors, family income

has a very considerable influence on child participation (Hof-

ferth & Sandberg 2001; King et al. 2003). For example, in a

sample of preschoolers, children with mild disability from

below average income families exhibited the lowest participa-

tion diversity scores (Rosenberg et al. 2010a). Among school

aged children with severe disabilities associations were found

between total family income and participation intensity in

active physical activities (King et al. 2002).

Naturally, parental factors also have a crucial affect on the

development and participation of young children (Bronfen-

brenner 1979; Case-Smith 2005). Parental perception of their

own parenting abilities affects the quality of the physical and

emotional environment they are able to provide for their chil-

dren (Bandura 1994; Coleman & Karraker 1997; Jones & Prinz

2005). Parental perception of their own ability is connected to

the term ‘parental self-efficacy’ – defined by Bandura (1994) as

the parental belief in their ability to organize and carry out a set

of tasks related to child nurturing. Parental self-efficacy is an

important component of parental self-image and is the basis

for parental practice. Furthermore, it predicts good parenting

ability, with regards to functionality, adaptation and parental

satisfaction (Bandura 1994; Coleman & Karraker 1997; Mon-

tigny & Lacharite 2005). As a consequence, parental self-efficacy

in common with other parenting factors may contribute to

child participation (King et al. 2006; Majnemer et al. 2008;

Dunn et al. 2009).

The literature review revealed that most of the studies assess-

ing participation of children focused on school aged children

with severe or MDD (e.g. Schenker et al. 2005; King et al. 2006;

Majnemer et al. 2008). Moreover, only a few studies assess the

concurrent effect of diverse personal and environmental factors

(Morris et al. 2005; King et al. 2006; Majnemer et al. 2008).

562 B. Soref et al.

© 2011 Blackwell Publishing Ltd, Child: care, health and development, 38, 4, 561–571

Hence, the aim of the present study is to broaden the knowledge

on the participation of younger children with and without

MDD – a topic yet to receive comprehensive attention. We

hypothesize that the: motor abilities; perceived self-efficacy;

maternal self-efficacy and; SES of the child will predict the

five measures of child participation varyingly – i.e. diversity

(number of activities the child participates in); intensity (fre-

quency of participation); independence (level of assistance);

enjoyment and; parental satisfaction.

Method

Participants

Sixty-three children and their parents were asked to participate

in the study. Four families refused to participate and an addi-

tional child was omitted from the data analysis because of a

sensory deficit, which was revealed later. Finally, 58 healthy pre-

schoolers and their parents participated in the study through

convenient sampling method. All children attended mainstream

kindergarten. Determination of sample size to test up to 10

explanatory variables was set to provide 80% power and signifi-

cance level of 0.05, as function of R2 = 0.25 (Cohen 1988;

Bartlett et al. 2001).

The study group comprised 29 children (23 boys) with an

average age of 5.14 years (SD = 0.46, range = 4.50–5.92 years),

recruited from outpatient paediatric occupational therapy

clinics. To enter the study group, participants had to be referred

for occupational therapy evaluation to assess for mild or mod-

erate developmental difficulties – including: gross motor diffi-

culties; clumsiness; visual motor difficulties; fine motor delays;

sensory modulation dysfunction; attention deficit disorder or

learning disabilities. We approached parents of children who

were referred for occupational therapy intervention, but who

were on the waiting list. The comparison group comprised 29

children (23 boys) with an average age of 5.28 (SD = 0.57, range

= 4.50–6.0 years) who had no developmental problems and had

never been referred for therapy. Participants of the comparison

group were recruited through an advertisement placed at

nearby mainstream kindergartens and community centres.

Children receiving special education, and with neuromuscular

diagnosis, such as cerebral palsy, or children with communica-

tion disorder (e.g. autism), and sensory loss (e.g. blindness and

deafness) were excluded from the study.

In our total sample 91.4% of the parents were married, and

most of the families had two children (57%). The years of

education for the mothers and fathers ranged from 10 to 23,

with the majority of them (51%) having had been educated for

at least 12 years. Most families participating in the study had an

above average income (72.4%) with only 10.35% having a below

average income.

Both groups of children were matched for: age; gender; age of

parents; the number of children per family; living environment

(urban or rural); parents’ education and; family income. No

significant differences were found between the study and com-

parison group in all the matched variables.

Measures

Child Participation Questionnaire (Rosenberg et al. 2010a)

The Child Participation Questionnaire (CPQ) is a question-

naire completed by parents of children aged 4–6 years. It mea-

sures the child participation pattern in six occupation domains:

Activities of Daily Living (e.g. dressing), Instrumental Activities

of Daily Living (e.g. setting the table), Play (e.g. imaginative

play, computer games), Leisure (e.g. bicycle riding, listening to a

story), Social participation (e.g. visiting a friend) and Education

(e.g. drawing and grapho-motor exercises in preschool class-

room). Five participation measures are yielded from the ques-

tionnaire: participation diversity; participation intensity; child

independence, enjoyment and; parental satisfaction. In the

current study these measures were calculated as mean total

scores of all the activities (44) in which a child participated.

Findings suggest that all the total measures of the CPQ have

good internal reliability – Cronbach’s coefficient alpha ranges

between 0.79 and 0.90. The Cronbach’s coefficient alpha for the

diversity was not calculated, being merely the total number of

activities. The CPQ has good temporal stability (Intra-Class

Correlation 0.84–0.89) measured in a 2-week interval. The con-

vergent and divergent validity of the CPQ were established

(Rosenberg et al. 2010b). The CPQ has proved to be a promising

new tool for assessing child participation (Rosenberg et al.

2010a).

Bruininks-Oseretsky Test of Motor Proficiency (Bruininks &Bruininks 2005)

The Bruininks-Oseretsky Test of Motor Proficiency (BOT2) is a

test of gross and fine motor proficiency for both children and

young adults within a range of 4–21 years of age. In this study

we used the short version of the test, which includes 14 items in

eight domains: fine motor precision; fine motor integration;

manual dexterity; bilateral co-ordination; balance; running

speed and agility; upper limb co-ordination and; strength. Each

item’s raw score is transferred into one composite score, ranged

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© 2011 Blackwell Publishing Ltd, Child: care, health and development, 38, 4, 561–571

from 0 to 88. This composite score can be transformed into

either scale score or percentile. This test is commonly used in

Israel for clinical evaluation and academic research (e.g. Rosen-

blum & Josman 2003; Bar-Haim & Bart 2006). The BOT2 has

good internal consistency (�0.80) and test–retest reliability

(�0.80) (Deitz et al. 2007). The test validity was established

both by content and construct validity, and by divergent and

convergent validity (Bruininks & Bruininks 2005).

Pictorial Scale of Perceived Competence and SocialAcceptance for Young Children (Harter & Pike 1984)

The original questionnaire was developed as a tool for assessing

the self-esteem of children between the ages 4 and 8 years. The

measure contains two subscales; perceived competence (cogni-

tive and physical) and perceived social acceptance (peer and

maternal). The measure contains 24 items – six for each

domain. The measure scale is from one (low competence/

acceptance) to four (high competence/acceptance), with a sub-

sequent grade range from 6 to 24 for each domain of the

measure. The raw score is the sum of all items. Specific norms

exist by gender and age. For this measure the internal consis-

tency reliability of individual subscales range from 0.50 to 0.85.

The reliability of the total scale is in the mid to high 0.80 s. In

this study the Hebrew version, adapted by Orr and colleagues

(1989) was used.

Parental Self-efficacy Questionnaire (Raviv & Bartal 1995)

The Parental Self-efficacy Questionnaire is addressed to parents

and phrased as both statements and questions. It comprises a

15-item 6-point Likert scale from 1 (not at all) to 6 (very much).

The total score is the sum of all items. High scores indicate

higher parental self-efficacy. The questionnaire has high inter-

nal validity – Cronbach’s coefficient alpha higher than 80. The

Self-efficacy Questionnaire is able to differentiate between help-

less mothers, mothers of children with motor difficulties

mothers of children with hyperactivity and mothers of typically

developed children (Lion 2001). Factor analysis yielded four

factors explaining 18.5% of the variance of the maternal ability

to set limits for her children – thus establishing the construct

validity of the questionnaire. In the present study we assessed

only maternal self-efficacy.

Socio-demographic Questionnaire

Information on the demographic, social and economic back-

ground of the child’s family was collected on a structured

questionnaire completed by the mothers. This included: age

(parents and child); gender; education and occupation of

both parents; socio-demographic factors (religion, ethnicity);

living conditions (type of dwelling, number of rooms);

family structure (type, size and siblings) and; family

income.

Procedure

Following the approval of the Behavioral Research Ethics Board

of Tel-Aviv University and the relevant community health ser-

vices, parents of all participants signed a consent form and

completed the CPQ, the Parental Self-efficacy Questionnaire

and the Demographic Questionnaire at their own convenience.

All the children were assessed in the occupational therapy clinic

using the BOT2 and the Pictorial Scale of Perceived Compe-

tence and Social Acceptance for Young Children (PSPCSA). This

assessment session lasted for about 40 min.

Statistical analysis

For the SES variable, we used the house density measure, calcu-

lated by dividing the number of rooms by the number of

inhabitants. To evaluate the differences between the study and

comparison groups, in all the explanatory variables (BOT2,

PSPCSA, Maternal Education, Maternal Self-efficacy and

SES) we computed independent t-tests. For the participation

outcome measures (diversity; intensity; child independence

child enjoyment and; parental satisfaction) we calculated mul-

tivariate analysis of variance.

To test the association between the various explanatory vari-

ables and the participation measures we calculated Pearson cor-

relations. To assess the extent to which participation measures

could be explained by the predictors, we calculated separate

multiple linear regressions using an Enter method. To examine

our hypothesis five separated linear regressions were conducted

for explaining: diversity; intensity; independence; enjoyment

and: parental satisfaction. In each regression model three steps

were performed: (i) individual factors measured by hands on

standardized tests (BOT2, PSPCSA); (ii) maternal characteris-

tics measured by questionnaires (Maternal Self-efficacy,

Socio-demographic); and (iii) SES (evaluated by house density

measure).

Both the variable selection and the order in which they

were entered are based upon theory and previous findings

(Law 2002; Chen & Cohn 2003; Case-Smith 2005; Bart et al.

2007). The level of significance was set at 0.05 for all statistical

tests.

564 B. Soref et al.

© 2011 Blackwell Publishing Ltd, Child: care, health and development, 38, 4, 561–571

Results

Participation, personal, maternal andenvironmental factors

The participants’ raw scores for explanatory variables and out-

comes participation measures, for the total sample, and for each

group, are presented in Table 1. Children with MDD scored

lower than children without developmental disabilities on the

personal explanatory variables (BOT2 and perceived compe-

tence), and on two of the outcome participation measures – i.e.

diversity and independence.

Correlations and regressions

When deciding which predictors were included in the regres-

sion model we calculated Pearson correlations between partici-

pation measures and explanatory variables. The results indicate

a significant correlation between child motor ability and the

subjective aspects of participation (i.e. independence, enjoy-

ment and parental satisfaction), but no significant correlation

between child self-efficacy and the outcome participation mea-

sures. Regarding environmental factors; a correlation was found

between maternal self-efficacy and all participation measures,

while none was found for the SES factor (for further details see

Table 2). To avoid the possibility of multicollinearity we calcu-

lated Pearson correlations between all the explanatory variables.

Results indicate that there were no significant correlations

between the variables (0.023 > r < -0.225), which would allow

for them to apply together for the forthcoming regressions

calculations.

Participation diversity (D)

Results revealed that the child self-efficacy (step 1) explains

11% of the variance of participation diversity [F(2,55) = 4.52, P

< 0.05]. Adding the maternal factors in step 2 [F(4,55) = 4.04,

P < 0.01, r2 = 0.18] and the SES factor in step 3 [F(5,55) = 4.79,

P = 0.001, r2 = 0.26] added 7% and 8% more each, respectively,

to the total explained variance. In total, 26% of the variance in

diversity was explained by this model (see Table 3).

Participation intensity (I)

The results indicate that the individual factors – i.e. motor

ability and child self-efficacy – in step 1, did not account in a

Table 1. Raw scores of explanatory variablesand outcome measure

Total

Control group Study group

t(56) P

n = 29 n = 29

Mean � SD Mean � SD Mean � SD

Range Range Range

Explanatory variablesBOT2 42.57 � 13.20 49.10 � 11.58 36.03 � 11.50 4.31 0.000

14–70 30–70 14–56Child self-efficacy 3.63 � 0.36 3.73 � 0.28 3.53 � 0.41 2.10 0.041

2.46–4.00 3.00–4.00 2.46–4.00Mother education (years) 13.79 � 2.49 13.86 � 2.61 13.71 � 2.40 0.22 0.825

10–20 10–20 10–20Maternal self-efficacy 5.12 � 0.56 5.12 � 0.59 5.12 � 0.53 0.05 0.963

3.67–5.93 3.67–5.93 3.80–5.93SES 0.94 � 0.27 0.92 � 0.22 0.96 � 0.32 -0.49 0.628

0.40–2.00 0.63–1.60 0.40–2.00Outcome measure – participation dimensions

Diversity 38.98 � 2.60 39.69 � 1.61 38.27 � 3.19 2.13 0.03928–43 37–43 28–42

Intensity 3.91 � 0.32 3.87 � 0.30 3.95 � 0.35 -0.86 0.3923.15–4.83 3.15–4.44 3.26–4.83

Child independence 5.27 � 0.48 5.42 � 0.37 5.13 � 0.54 2.37 0.0213.78–5.90 3.78–5.90 3.78–5.88

Child enjoyment 5.45 � 0.47 5.52 � 0.36 5.38 � 0.55 1.18 0.2423.95–6.00 4.29–5.98 3.95–6.00

Parent satisfaction 5.30 � 0.63 5.44 � 0.51 5.17 � 0.71 1.67 0.1013.82–6.00 3.88–6.00 3.82–6.00

BOT2, Bruininks-Oseretsky Test of Motor Proficiency; SES, socio-economic status.

Pathways to young children’s participation 565

© 2011 Blackwell Publishing Ltd, Child: care, health and development, 38, 4, 561–571

significant manner for the explained variance of participation

intensity [F(2,55) = 0.049, P > 0.05]. However, entering the

maternal self-efficacy score in step 2 contributed 13% to the

total explained variance [F(4,55) = 3.02, P < 0.05, r2 = 0.13].

The SES factor in the third step results in only a minor contri-

bution – less than 1% more to the total explained variance

[F(5,55) = 2.74, P < 0.05, r2 = 0.14] (see Table 3).

Independence (Ind)

Results indicate that 17% of the variance of Independence was

explained by motor ability in step 1 [F(2,55) = 6.56, P < 0.01].

Including maternal self-efficacy in step 2 increased the

explained variance by 17% more [F(4,55) = 7.99, P < 0.0001,

r2 = 0.34]. Entering the SES in step 3 made an insignificant

contribution [F(5,55) = 6.70, P < 0.0001, r2 = 0.34]. In total, 34%

of the variance of independence was explained by this model

(see Table 3).

Enjoyment (E)

The regression results presented in Table 4 indicate that motor

ability in step 1 explained only 8% of the variance [F(2,55) =3.28, P < 0.05, r2 = 0.08], while maternal factors (maternal

self-efficacy and education) in step 2 increased the explained

variance upwards to 34% [F(4,55) = 8.14, P < 0.0001, r2 = 0.34].

Adding the SES in step 3 made an insignificant contribution to

the explained variance of enjoyment [F(5,55) = 6.67, P < 0.0001,

r2 = 0.34].

Parental satisfaction (PS)

The results revealed that the unique contribution of child

factors alone (6%) could not account, in a significant manner,

for the variance of parental satisfaction [F(2,55) = 2.83, P > 0.05,

r2 = 0.06]. Entering the maternal factors in step 2 significantly

increased the explained variance up to 26% [F(4,55) = 5.83,

P = 0.001, r2 = 0.26], while step 3, slightly lessened the total

explained variance of parental satisfaction [F(5,55) = 4.58,

P < 0.01, r2 = 0.25] (see Table 4).

Discussion

The study assessed the contribution of child and environmental

factors on various dimensions of preschoolers’ participation

and engagement in their daily activities. In all, the study results

indicate that the combination of children’s and environmental

factors significantly though differentially contributed to the

five dimensions of participation (Diversity; Intensity; Indepen-

dence; Child Enjoyment and Parental Satisfaction).

Child factors

Motor abilities

Given that motor abilities are essential for child development

and participation (Law 2002; Chen & Cohn 2003; Case-Smith

2005; Bart et al. 2007; Summers et al. 2008) our results are not

surprising. Motor abilities were also significant predictors

for parental satisfaction, child enjoyment and especially child

independence.

Motor abilities enable the child to successfully perform daily

activities in an appropriate manner consistent with his age

(Summers et al. 2008). Motor performance was found to be a

significantly explanatory variable for child participation (Law

et al. 2004), using fine motor skills and bilateral co-ordination,

even in such mundane daily activities as putting on a shirt and

fastening buttons. Children with motor deficit are likely to

experience difficulties in such basic self-maintenance activities.

Summers and colleagues (2008) found that children with devel-

opmental co-ordination disorder are less independent regard-

Table 2. Pearson correlations between personal and environmental factors with participation measure

Participation measures

Personal and environmentalfactors Diversity Intensity Independence Enjoyment Parental satisfaction

BOT2 0.168 -0.027 0.417** 0.331* 0.297*Child self-efficacy 0.213 -0.018 0.091 0.014 0.088Maternal self-efficacy 0.298* 0.405** 0.408** 0.308* 0.326*Mother education (years) 0.138 -0.174 -0.263* -0.485** -0.418**SES 0.262 -0.167 0.060 0.010 -0.057

*P < 0.05, **P < 0.001.BOT2, Bruininks-Oseretsky Test of Motor Proficiency; SES, socio-economic status.

566 B. Soref et al.

© 2011 Blackwell Publishing Ltd, Child: care, health and development, 38, 4, 561–571

ing the activities of daily living (e.g. dressing, eating and

personal hygiene) in comparison with their typically developing

peers.

As expected, a positive association between child’s motor

ability and his/her enjoyment was found. Children with better

motor performance have a positive experience performing tasks

(Bart et al. 2007) and thus enjoy their activities (King et al. 2003;

Denissen et al. 2007). Wortniac and colleagues (2006) proved

positive correlations between motor abilities and the enjoyment

from participating in sporting activities, while conversely,

children with motor disabilities such as developmental

co-ordination disorder experience less enjoyment while per-

forming their daily tasks and activities (Mandich et al. 2003;

Summers et al. 2008). Our study provides additional quantita-

tive data to previous qualitative studies (Mandich et al. 2003;

Missiuna et al. 2007; Summers et al. 2008). We also found that

child motor ability – albeit, at a low percentage – contributed to

parental satisfaction. This result can be considered together

with previous findings, which show that parents of children

with motor disabilities are more concerned about their child’s

participation than parents of typically developed children

(Rogers & White 1998; Montigny & Lacharite 2005; Missiuna

et al. 2007). In other words, we have shown that the higher the

Table 3. Model summary for explaining diversity, frequency andindependence

Variables B SE B b R2 (adj)

Participation diversityStep 1 0.114BOT2 – – 0.241Child self-efficacy 2.365 0.898 0.339*Step 2 0.181BOT2 – – 0.242Child self-efficacy 2.452 0.880 0.352**Maternal self-efficacy 1.161 0.563 0.257*Mother education (years) – – 0.226Step 3 0.256BOT2 – – 0.207Child self-efficacy 2.747 0.847 0.394**Maternal self-efficacy 1.210 0.537 0.268*Mother education (years) – – 0.163SES 6.407 2.577 0.304*

Participation intensityStep 1 -0.036BOT2 – – -0.033Child self-efficacy – – -0.033Step 2 0.128BOT2 – – -0.058Child self-efficacy – – -0.098Maternal self-efficacy 0.241 0.076 0.406**Mother education (years) – – -0.109Step 3 0.137BOT2 – – -0.039Child self-efficacy – – -0.120Maternal self-efficacy 0.237 0.076 0.400**Mother education (years) – – -0.075SES – – -0.163

Child independenceStep 1 0.168BOT2 0.002 0.005 0.443***Child self-efficacy – – 0.160Step 2 0.337BOT2 0.0015 0.004 0.417***Child self-efficacy – – 0.088Maternal self-efficacy 0.323 0.099 0.368**Mother education (years) – – -0.178Step 3 0.341BOT2 0.001 0.004 0.402***Child self-efficacy – – 0.106Maternal self-efficacy 0.327 0.098 0.372**Mother education (years) – – -0.205SES – – 0.133

*P < 0.05, **P < 0.01, ***P < 0.001.BOT2, Bruininks-Oseretsky Test of Motor Proficiency; SES, socio-economicstatus.

Table 4. Model summary for explaining child’s enjoyment and parentalsatisfaction

Variables B SE B b R2 (adj)

Child enjoymentStep 1 0.077BOT2 0.001 0.005 0.336*Child self-efficacy – – 0.029Step 2 0.342BOT2 0.001 0.004 0.300**Child self-efficacy – – -0.076Maternal self-efficacy 0.219 0.094 0.261*Mother education (years) -0.008 0.022 -0.424***Step 3 0.340BOT2 0.001 0.004 0.288*Child self-efficacy – – 0.061-Maternal self-efficacy 0.222 0.094 0.265*Mother education (years) -0.009 0.023 -0.446***SES – – 0.108

Parental satisfactionStep 1 0.062BOT2 0.001 0.006 0.313*Child self-efficacy – – 0.087Step 2 0.260BOT2 0.001 0.005 0.282*Child self-efficacy – – -0.003Maternal self-efficacy 0.340 0.132 0.306*Mother education (years) -0.008 0.031 -0.309*Step 3 0.246BOT2 0.001 0.006 0.279*Child self-efficacy – – 0.001Maternal self-efficacy 0.341 0.133 0.306*Mother education (years) -0.008 0.032 -0.314*SES – – 0.024

*P < 0.05, **P < 0.01, ***P < 0.001.BOT2, Bruininks-Oseretsky Test of Motor Proficiency; SES, socio-economicstatus.

Pathways to young children’s participation 567

© 2011 Blackwell Publishing Ltd, Child: care, health and development, 38, 4, 561–571

level of child motor ability and subsequent child participation,

the greater the corresponding parental satisfaction.

Child self-efficacy

Having considered previous research we had presumed that

child self-efficacy will predict a child’s level of participation –

the literature states that self-efficacy is related to motivation and

task persistence and thus it is a contributing factor to partici-

pation (Chen & Cohn 2003; Missiuna et al. 2006). However, the

results of this study have proved that child self-efficacy contrib-

uted only to participation diversity. Children with motor diffi-

culties tend to avoid participation in certain activities and so

exhibit less diversity. Nevertheless, higher perceived self-efficacy

may compensate for the motor disability and thus allow the

disabled child to experience and participate in diverse activities.

Child self-efficacy did not influence other dimensions of par-

ticipation, as young children generally tend to exhibit very high

self-efficacy perception. Perceived self-efficacy of preschoolers is

based upon what children believe they can do rather than upon

what they actually can do. Young children tend to be more

concerned with their actions themselves, rather than the conse-

quences of their actions (Missiuna & Pollock 2000; Rodger et al.

2003; Bandura 2006). In conclusion, child factors (motor abili-

ties and self-efficacy) explained only 17% of child independence

and 11% of the participation diversity. Therefore, additional

factors will be discussed to help us better understand child

participation.

Environmental factor

Maternal self-efficacy

Maternal self-efficacy contributed to all aspects of participation

and was the sole predictor for participation intensity. Maternal

self-efficacy is not merely the basis of parental practice; it is also

thought to be one of the environmental factors, which deter-

mine the quality of the physical and emotional environment

that parents provide for their children – thus promoting

participation (Bandura 1994; Coleman & Karraker 1997;

Kielhofner 2002; Case-Smith 2005; Summers et al. 2008).

Highly efficacious mothers successfully manage both the physi-

cal and the emotional daily routines of their children, so pro-

viding them with sufficient and appropriate challenges (Chen &

Cohn 2003). As a result their children will participate in a broad

range of activities, and will develop self-reliance and more

independence.

The unique contribution of maternal self-efficacy to partici-

pation intensity can be explained in the context of the tradi-

tional role of the mother, who typically spends a large amount

of time with her children, and is responsible for their daily

routines (Freysinger 1994; Hastings & brown 2002). Research

proves that mothers hold high levels of maternal self-efficacy in

managing their child’s routines and daily habits (Meunier &

Roskam 2009).

The higher the level of maternal self-efficacy, the greater the

challenges with which the mother can cope while undertaking

her parenting tasks, all of which results in higher levels of paren-

tal satisfaction (Coleman & Karraker 1997; Hamill et al. 2002).

Mothers with high maternal self-efficacy exhibit more warmth

towards, and acceptance of, their children who, in their turn

may experience more pleasure and satisfaction in their daily

lives (Jones & Prinz 2005). Pajares (2006) argues that self-

efficacy has a self-propagating nature – in that parents with high

levels of self-efficacy produce children with a strong sense of

general well-being and who enjoy full participation, which, in

turn, produces parents with increased levels of satisfaction.

Mother’s education

Our findings, which indicate that high levels of maternal edu-

cation contribute negatively to child enjoyment and parental

satisfaction, were not anticipated. Previous studies have found a

strong correlation between levels of parental education and

parental expectations of child achievement in school (Davis-

Kean 2005). In addition, it was found that socio-demographic

variables – including maternal education – affect the expecta-

tions of parents around the time their children reach develop-

mental milestones. Highly educated mothers expect their

children to achieve motor and cognitive milestones earlier than

poorly educated mothers (Williams et al. 2000). In other words,

the greater educated the mother, the higher her expectations for

her children. Unfortunately, children encumbered with the

pressure of their parents’ high demands and expectations

experience less enjoyment in participation in daily activities,

resulting in less maternal satisfaction (Barkauskiene 2005).

Socio-economic status

Socio-economic status was found to influence the diversity of

child participation. This finding is in agreement with the litera-

ture and indicates that SES is positively correlated to child

participation (Bianchi & Robinson 1997; Law 2002; Law et al.

2006). Studies found that children from high SES families

attended more formal activities in contrast to children from

568 B. Soref et al.

© 2011 Blackwell Publishing Ltd, Child: care, health and development, 38, 4, 561–571

families with low SES, who attended more free of charge infor-

mal activities (Simpkins et al. 2005; Ziviani et al. 2008).

Conclusions and limitations

In the main, our findings clearly demonstrate and emphasize

the significant contribution of child and environmental factors

to child participation. The environmental factors significantly

increased the total explained variance beyond the contribution

of the child factors alone. Results suggest that the total explained

variance is more than doubled when the environmental vari-

ables are inserted into the regression model. The study expands

our knowledge, and contributes to our understanding of child

participation, both of its facilitating and restricting factors.

Demographic limitations (most of the children were from

urban communities) and sample size restrict our ability to gen-

eralize the results and to draw conclusions regarding different

populations. In the present study we have focused on maternal

factors, which were found to be significant predictors of young

children’s participation. Further studies may assess the influ-

ence of paternal factors.

Implications for practice

Our findings can assist in the evaluation process and help the

development of intervention programmes to enhance partici-

pation and well-being. In order to fully understand child par-

ticipation, based on our findings, it is recommended to include

physical and human environmental factors in the evaluation

protocol besides child abilities. Moreover, increasing maternal

efficacy through specific intervention (parents groups, supervi-

sion or modelling) might result in increased child participation.

Key messages

• Participation diversity (number of activities) was pre-

dicted by child and mother self-efficacy and by socio-

economic status.

• Child independence, child enjoyment and parental satis-

faction were predicted by child motor ability but mainly by

maternal self-efficacy.

• Results suggest that the total explained variance is more

than doubled when the environmental variables are

inserted into the regression model.

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