Barriers to voluntary participation in sport for children: A systematic review

Numerous studies have detailed the physical health benefits of children’s participation in sport and a growing body of research also highlights the benefits for mental health. Children who participate in sport have also been shown to be advantaged academically.

R E S E A R C H A R T I C L E Open Access

Barriers to voluntary participation in sport

for children: a systematic review

Abstract

Background: Numerous studies have detailed the physical health benefits of children’s participation in sport and a growing body of research also highlights the benefits for mental health Children who participate in sport have also been shown to be advantaged academically However, despite the benefits there is evidence that children are leading increasingly sedentary lifestyles and are at greater risk of chronic disease than those with active lifestyles Sport provides an important means for children to achieve their recommended amount

of daily physical activity This systematic review asks ‘what are those barriers to children’s participation in sport?’

Methods: Literature searches were carried out in June 2015 using; EMBASE, Medline, CINAHL and SportDiscus using the search terms barrier*, stop*, prevent*, participat*, taking part, Sports/, sport*, “physical education”,

PE, child*, young person*, adolescen* These were supplemented with hand searches A total of 3434 records were identified of which 22 were suitable for inclusion in the review, two additional studies were identified from Google Scholar in November 2016 Both qualitative and quantitative studies were included Study’s included in the review assessed children up to 18 years of age Study quality was assessed using Critical Appraisal Skills Programme (CASP) tools

Results: Studies took place in the school environment (n = 14), sports club (n = 1), community setting (n = 8) and adolescent care setting (n = 1) Frequently reported barriers across quantitative studies were ‘time’ (n = 4), ‘cost’ (n = 3),

‘opportunity/accessibility’ (n = 3) and ‘friends’ (n = 2) Frequently reported barriers across qualitative studies were ‘time’ (n = 6), 'cost' (n = 5), 'not being good at sport' (n = 6) and ‘fear of being judged/embarrassed’ (n = 6)

Conclusion: Policy makers, parents and teachers should all be aware that ‘cost’ and ‘time’ are key barriers to participation in sport More local sports opportunities are needed where costs are reduced Schools and local clubs could better work together to provide more affordable local opportunities to increase children’s

participation in sport

Keywords: Sport, Participation, Barriers

Background

Sport is defined as an“an activity involving physical

ex-ertion and skill in which an individual or team competes

against another or others for entertainment” [1] Sport

can involve moderate or vigorous physical activity

Sports involving moderate physical activity include those

such as badminton or cricket, where a person can

converse easily at the start of play but breathing be-comes more effortful as they continue play Sport involv-ing vigorous physical activity includes those such as competitive swimming where there is exertion and phys-ical demands are high, e.g on the person breathing [1] For most children physical education (PE) provides the first exposure to sport [2,3] and it is likely that this early exposure is very influential of their participation in later years [4]

Children show benefit from participation in sport in terms of mental and physical health and school perform-ance [5–8] Numerous studies detail the physical health

* Correspondence: sarah.somerset@nottingham.ac.uk

1

National Institute for Health Research (NIHR) Nottingham Biomedical

Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham NG1 5DU,

England

2 Otology and Hearing Group, Division of Clinical Neuroscience, School of

Medicine, University of Nottingham, Nottingham NG7 2UH, England

© The Author(s) 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made The Creative Commons Public Domain Dedication waiver

benefits of participation in sport and there is also a

grow-ing body of research investigatgrow-ing the psychological and

mental health benefits [9,10] Children who participate in

sport are shown to score higher on scales for happiness,

mental health and physical health compared to those not

participating in sport [7] Regular participation in sport

has also been linked to better quality of life [9] However,

despite all the known benefits, children are also leading

increasingly sedentary lifestyles, associated with increased

risk of obesity and chronic diseases such as diabetes and

coronary artery disease [11,12]

Sports are an important means for children and young

adults to gain their recommended level of physical

activ-ity [13] The Health and Safety Executive (2012) state

vigorous activities (those strengthening muscle and bone

such as swimming, running or football) should be

car-ried out on at least three days per week [13] The WHO

[14] guidelines for physical activity for children and

young people aged 5 to 17 years is for at least 60 min of

exercise such as swimming, tennis, rugby, football or

squash per day [13, 15, 16] Boys participate in sport

more frequently than girls and are more physically active

from childhood into adolescence [13,17–19] A study in

Europe focusing on children aged 9 to 15 years showed

sports participation decreased across all ages in all

coun-tries [20] Worryingly this pattern is seen across the

world with global estimates showing that 80% of 13 to

15 year olds do not meet the guided amount of physical

activity including sport [21]

For the purposes of this review physical education

(PE) is also considered part of sport This review does

not focus on physical activity but instead views sport as

a subset of physical activity

Previous research in the UK found that from ages

of PE and out of hours school sport, but this

de-creased when children moved from primary (ages ~

in the UK [22] Quick et al [22] conducted a series

of surveys to establish the proportion of pupils

receiv-ing two hours of curriculum PE and the proportion

of pupils participating in at least three hours of high

‘physical activity’ terms, barriers such as ‘preferences

and priorities’, ‘family life’ and ‘parental support’ can

influ-ence levels of sports participation [23] Allender et al [4]

identified ‘being highly structured’ and ‘being a

competi-tive actvity’ as potential barriers to participation in sport

and other physical activity in young children

In terms of facilitators of sports participation much of

the current literature focuses on more specific barriers

such as those faced by people with physical disability,

visual impairment, or those in economically

disadvan-taged areas [24–26] There are few current studies which

examine facilitators in the more general population [27] This may be a reflection in part that the evidence for what general barriers children face when they wish to participate in sports has yet to be synthesised Here we systematically review studies primarily concerned with identifying general barriers to voluntary sports participa-tion faced by all children and consider how these bar-riers might best be addressed

The aim of this systematic review was to identify and synthesise the primary evidence on barriers to voluntary sports participation that are faced by children, and to then consider how those barriers might best be addressed

Methods

The protocol for this systematic review was prospect-ively registered on PROSPERO (CRD42015023993) and

www.crd.york.ac.uk/PROSPERO/display_record.asp?ID= CRD42015023993)

Searches

Literature searches were carried out in June 2015 using four electronic databases; EMBASE, Medline, CINAHL and SportDiscus using the search terms barrier*, stop*, prevent*, participat*, taking part, Sports/, sport*, “phys-ical education”, PE, child*, young person*, adolescen*

An example search can be found in Appendix Authors

of the systematic reviews identified in the initial searches were also contacted to see if they were aware of any other relevant studies Searches were updated in November

2016 with an additional search of Google Scholar Search terms were simplified for Google Scholar to child*, bar-rier*, sport, and participation [28,29] A stopping rule was prospectively applied to the Google Scholar search results whereby screening of titles and abstracts was stopped after three consecutive pages where no new records were taken forward to full text screening

Inclusion / exclusion

This review is specifically focused on the barriers to chil-dren’s voluntary participation in sport Only peer-reviewed records, describing original research and avail-able in English, were included Studies were required to discuss barriers to voluntary participation in sport in children up to the age of 18 years

Studies were excluded if they only concerned the im-pact of non-participation in sport or the effects sports participation can have on variables such as the female athlete triad, smoking, or alcohol consumption Studies where sport was included as an intervention (i.e.‘forced’ participation) were excluded Studies were also excluded

if they only reported on participants with additional needs or were focused on injury from sports

were excluded Studies were excluded if they did not

in-vestigate barriers to participation in sport or were not

about participation in sport Both qualitative and

quanti-tative records were included

Study selection

A title screen was carried out by researcher 1 (SS) to

re-move any duplicates from the searches Abstract

screen-ing was conducted independently by both authors Any

studies identified by either researcher as either providing

likely or unclear evidence for inclusion were retrieved

for full text review The full texts were then

independ-ently reviewed against the inclusion/exclusion criteria by

both authors A consensus meeting was held to

deter-mine the extent of agreement and to resolve any

dis-agreement, and agree the records to be included

Data extraction

A data extraction form was developed, piloted on four

records, and revised before data extraction began Both

author’s independently extracted data, and discrepancies

were reviewed and resolved through discussion and

revi-siting the record Extracted data included author, year of

publication, country or location of study, study design,

number of participants, age range of children in the

study, type of barrier to participation, socioeconomic

in-formation, type of sport, and whether sport took place in

or out of school

Study appraisal

To appraise quantitative studies we used the Clinical

Ap-praisal Skills Programme (CASP) tool for cohort studies

[30] This tool contains 12 questions Questions 3, 4, 6

and 12 were not used however as they are only relevant to

intervention studies (Table1) For each question there are

three response ratings:‘yes’,‘no’, or ‘can’t tell’

For qualitative studies we used the Clinical Appraisal

Skills Programme (CASP) tool for qualitative studies

[31] This tool contains ten questions (Table2) For each

question there are three response ratings: ‘yes’, ‘no’, or

‘can’t tell’

Study appraisal was conducted independently by the

two authors and any disagreements in scoring were

re-solved through discussion and revisiting the record

Results

The initial searches produced 3434 records of which 22

studies met the criteria for inclusion; 9 quantitative

stud-ies and 13 qualitative (see Fig 1 for flow diagram) An

additional search of Google Scholar in November 2016

identified two additional studies which met the criteria

for inclusion, one qualitative and one mixed methods

Study characteristics are given in Tables3and4 Studies

club (n = 1), community setting (n = 8) and adolescent care setting (n = 1) Of the studies nine quantitative and eight qualitative studies made use of male and female participants whilst seven of the qualitative studies had female only participants Socioeconomic information was reported in five of the quantitative studies and nine

of the qualitative studies

The quantitative studies included took place in France (n = 1), Australia (n = 3), USA (n = 4) and Spain (n = 1) The qualitative studies included were conducted in Australia (n = 3), Brazil (n = 1), Canada (n = 1), Ireland (n = 1), UK (n = 5) and USA (n = 4) Across all studies participants ranged in age from 4 to 19 years

Study appraisal

Study appraisal against the CASP questions is given in Tables1and2

In general studies met most criterion for quality; of

222 judgements 161 were that‘yes’ that quality criterion

is met, 41 were‘no’ that the criterion was not met, and 20

made for that criterion/study There was also observable trends across study types Across quantitative studies for example, all were judged to have recruited in an accept-able way and almost all were judged to not have identified all important confounding factors For qualitative studies, all were judged to have appropriately selected a qualitative approach to their research, whereas few reported or made clear that the relationship between researchers and partici-pants had been adequately considered

is given in Additional file1 with some illustrative exam-ples here

In the study by Gordon [32] it was unclear if the study addressed a clearly focused issue and was rated as ‘can’t tell’ Two of the nine quantitative studies were judged to have identified all important confounding factors and took them into account in their design and analysis Some caution should be attributed when using the re-sults from Kirshnit [33], Irwin [34] and Hardy [35] as they scored‘no’ on several quality questions

In the qualitative studies it was unclear if the research design was appropriate for Barnett 2013 and Dismore [36] It was also not clear if the recruitment strategies used by Azzarito [37] and Dismore [36] were appropri-ate Differences in results may be explained by the differ-ences in quality of the studies

There is a potential bias in the quantitative studies as almost all were judged to not have identified all import-ant confounding factors and as such analysis did not ac-count for these Four quantitative studies [32–35] were scored‘no’ on the majority of the quality appraisal ques-tions Those studies addressed a focused issue but did

sport participation in

studies Arment

2012 [

2013 [

Dismore 2010 [

Eime 2010 [

Ei Enri

Fi 2013 [

2011 [

Kimm 2006 [

Oliver 2009 [

Q 2011

2012 [

Wetto 2013 [

not take account of confounding factors in either the

de-sign or analysis of the results and the precision of the

re-sults was questioned Some did not list odds ratios and

confidence intervals making it difficult to assess the

accur-acy of their findings [32–35]

Few qualitative studies reported or discussed the

nature of the relationship between researchers and

par-ticipants It is therefore concerning that Barnett [38],

Eime [39], Eimear-Enright [40], Fisette [41], Holt [42],

Oliver [43], Stanley [44] and Totaro-Garcia [45] do not

clearly provide this information The majority (n = 10) of

the qualitative studies scored as‘Yes’ to sufficient rigour

in data analysis indicating a well thought out and

con-structed process

The estimates (barriers) reported in the two

quantita-tive studies [30, 46], and one the qualitative study [41]

which scored‘yes’ on all CASP criteria provide high level

evidence, i.e replication of the study is unlikely to

change the estimates For qualitative studies we did not

consider criterion 10 in this judgement as it is not

rele-vant to reliability All other studies were judged to have

some factor or factors that might impact on the

reliabil-ity of their estimates, i.e further studies that do address

these reliability issues may report different results

Barriers to sports participation

Study characteristics of the nine quantitative studies are

shown in Table 4 Eight quantitative studies focused on

the generic sports [32, 33, 46–50] context with one

fo-cusing on swimming participation alone [34] in children

aged 5 to 18 years All quantitative studies made use of

questionnaires and surveys Boiche [46] investigated

po-tential factors for dropout in sport or continuation of

sport Perry [49] sought to identify perceptions of moti-vators and barriers to physical activity, including sports participation Irwin [34] also sought to identify barriers and facilitators to participation but focused on swimming Casper [47] sought to identify constraints to participation

in physical activity including sports participation and how these differ across age, gender, socioeconomic status

position and sport participation and how varying so-cioeconomic position influenced personal, social and environmental factors for participation in physical ac-tivity including sports Gordon [32] focused on leisure activity involvement (including sports participation) All studies reported the relationship between gender and sports participation and the effect of increasing age Two studies made use of predefined barriers for

used electronic pagers to assist children with filling out a survey Random messages were sent out to the pagers and on receipt children were asked to respond

to a short survey All quantitative studies made use of questionnaires and surveys The most frequently reported barriers across the quantitative studies were‘time’ (n = 4),

‘cost’ (n = 3),‘opportunity/accessibility’ (n = 3) and ‘friends’ (n = 2) Where‘friends’ was listed as a barrier studies had reported that children did not have friends to attend ses-sions with, or that they had no friends at the sport session and hence no one to partner with

Across qualitative studies, one study focused on paren-tal views of their child’s participation in sport [51] and another study looked at both parent and child perspec-tives of the benefits associated with participation in sport low income families [42] Almost half of the qualitative studies focused on female experience of participation in

Fig 1 PRISMA flow diagram PRISMA flow diagram showing the records identified, duplicates removed, full text articles assessed for eligibility and studies included

association relationship

inapproprisate prractice

negative relationship

sociodemographic groups

dimensions, intrapersonal, interpersonal

between socioeconomic

environmental mediators

South Australia

socioeconomic background:

Medium socioeconomic background:

socioeconomic background:

Low socioeconomic background

socioeconomic background reported

association relationship

parents Lack

underrepresented youth.

encouragement from

USA, Chicago

association relationship

intrapersonal perceptions

meeting recommended

Table 4 Study characteristics for the qualitative studies included in the review

Author &

Year

Research Aim Method Sample Country Age

(Years)

or School Grade

Sport Socioeconomic info

Barriers Identified

Negative causaul/association relationship

Armentrout

2011 [ 51 ]

To establish a clear

and specific

understanding

of organisational

barriers and

personal reasons

that may lead

youth to

discontinue

sport participation

and to determine

changes that

could be made

to lead to

continued

involvement.

Survey open ended questions

237 parents/

guardians of children who had been youth hockey players

USA Minnesota

4–17 Ice Hockey Outside school

NR Lack of time

Cost too high Location too far Availability of ice rink Politics affecting participation Lack of enjoyment Lack of interest

Causal

Azzarito

2013 [ 37 ]

To explore the

geographical

dimensions of

ethnic-minority

girls moving

bodies as

manifested in

relevant spaces

and places of

their daily lives

Visual ethnography with 2 interviews

20 females United

Kingdom Midlands

14 –15 PE Inside School

19 ethnic minority F,

1 white F

Fear of humiliation Self-consciousness Competitiveness Negative appraisal Conformity

Association

Barnett

2013 [ 38 ]

To explore

adolescents’

perception of the

relationship between

movement skills,

PA and sport, and

whether their

perceptions

differed

according to

extent of

participation

in organised PA.

Focus groups 33 17

(52%) M

16 (48%) F

Australia 16–18 General

Outside school

99% below average Australian socioeconomic status

Not being good

at sport Cost too high Lack of time

No Encouragement Lack of resources Fear of being judged

Causal

Basterfield

2016 [ 54 ]

To investigate how

perceived barriers

to participation in

school and outside

school sports club

change in the same

cohort over 3 years.

Three main

hypothesis were

tested: 1 Perceived

barriers will change

from 9 to 12 years,

2 Overweight

children will perceive

different barriers to

children of healthy

weight, 3.girls will

perceive different

barriers than boys

Survey with open ended questions

441,210 (48%) M

231 (52%)

England 9 and

12 years General Socioeconomically representative of Northern England

Cost too high Distance to training Lack of facility Lack of time Being shy Doesn ’t like being

a teacher Doesn ’t like strangers Being bullied Lack of skill Fear of getting hurt Fear of making a mistake

Causal

Dismore

2010 [ 36 ]

To investigate

children’s attitudes

toward PE and

school sport?,

Interview 10

5 M

5 F

United Kingdom

Year 7 PE Inside School

Mixed state and grammar schools

Conforming to social groups Lack of access

to (good) equipment School PE curriculum

Causal

Eimear

Enright

2010 [ 40 ]

To investigate

what a negotiated

PE curriculum

Participatory action research

41 F Ireland 14 –19 PE NR Lack of voice

and choice

Causal