The mediating role of the environment in explaining participation of children and youth with and without disabilities across home, school, and community.
OBJECTIVE
To test the effect of personal and environmental factors on children's participation across 3 different settings (home, school, community); to ascertain the interrelations between these factors; and to propose and test 3 models, 1 for each setting, using structural equation modeling.


METHODS
Survey, cross-sectional study, and model testing.


METHODS
Web-based measures were completed by parents residing in North America in their home/community.


METHODS
Parents (N=576) of children and youth with and without disabilities, (n=282 and n=294, respectively), ages 5 to 17 years (mean age, 11y 2mo), completed the Participation and Environment Measure for Children and Youth (PEM-CY).


METHODS
Not applicable.


METHODS
The PEM-CY measured levels of participation frequency and involvement, as well as environmental barriers and supports of participation, in each of the following 3 settings: home, school, and community. Information about the child's health condition and functional issues was also collected.


RESULTS
All 3 models fit the data well (comparative fit index, .89-.97) and explained 50% to 64% of the variance of participation frequency and involvement. Environmental barriers and supports served as significant mediators between child/personal factors (income, health condition, functional issues) and participation outcomes, across all models. The effect of the environment was most pronounced, however, in the community setting.


CONCLUSIONS
Our findings highlight the unique role of the environment in explaining children's participation across different settings and, therefore, support the development of interventions targeting modifiable environmental factors.
School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada. Electronic address: dana.anaby@mcgill.ca.
Dana
D
Anaby
School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.
Mary
M
Law
Department of Occupational Therapy, Sargent College of Rehabilitation Sciences, Boston University, Boston, MA.
Wendy
W
Coster
Department of Occupational Therapy, Tufts University, Medford, MA.
Gary
G
Bedell
Department of Occupational Therapy, Colorado State University, Fort Collins, CO.
Mary
M
Khetani
Avery Information Services Ltd, Orilla, Ontario, Canada.
Lisa
L
Avery
CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.
Rachel
R
Teplicky
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D019988:Children with Disabilities / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology*; D012111:Residence Characteristics; D012574:Schools; D012931:Social Environment; D058992:Social Participation; D011795:Surveys and Questionnaires
Disabled children; Environment; Rehabilitation; Social participation