The mediating role of the environment in explaining participation of children and youth with and without disabilities across home, school, and community

Arch Phys Med Rehabil. 2014 May;95(5):908-17. doi: 10.1016/j.apmr.2014.01.005. Epub 2014 Jan 24.


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.

Design: Survey, cross-sectional study, and model testing.

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

Participants: 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).

Interventions: Not applicable.

Main outcome measures: 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.

Keywords: Disabled children; Environment; Rehabilitation; Social participation.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Disability Evaluation*
  • Disabled Children / psychology
  • Disabled Children / rehabilitation*
  • Female
  • Humans
  • Male
  • Parents / psychology*
  • Residence Characteristics*
  • Schools*
  • Social Environment*
  • Social Participation*
  • Surveys and Questionnaires