Physical activity experiences of youth with visual impairments: An Alaskan perspective

Abstract

The purpose of this study was to explore the physical activity experiences of youth with visual impairments living in Alaska. This study utilized a descriptive-qualitative methodology using an exploratory case study design. A convenience sample of four (one female, three males; aged 12–18 years) Alaskan youths with visual impairments participated in this study. Data included semi-structured interviews, reflective interview notes, and observational notes. Data were transcribed verbatim, and thematic development was undertaken inductively using a three-step analytic process. Based on the analysis, two interrelated themes emerged from the data: (a) “I don’t really participate in sports other than at camp”: preferences for unstructured activities and (b) “my sister’s willing to do anything”: familial impact on physical activity. Results of this study can help inform future efforts to promote physical activity engagement among youth with visual impairments, particularly those living in geographic areas similar to Alaska.

Keywords

Adapted physical activity blindness disability quality of life vision

Introduction

Important and favorable health effects of physical activity have been well documented (Centers for Disease Control and Prevention [CDC], 2011; Kriemler et al., 2011). For example, regular engagement in physical activity can lead to decreases in health-related issues (e.g. obesity, diabetes) while enhancing quality of life (CDC, 2011; Haegele, Famelia, & Lee, 2016). By developing a physically active lifestyle at an early age, individuals can decrease the chances of developing health-related issues later in life while preventing chronic disease in childhood (CDC, 2011). As such, the World Health Organization (WHO; 2010) recommends children and youth (aged 5–17 years) to accumulate at least 60 min of moderate to vigorous intensity physical activity daily. Unfortunately, however, youth with visual impairments (i.e. those with low vision and complete blindness) tend not to meet established physical activity guidelines and are less likely to engage in regular physical activity than their sighted peers (Augestad & Jiang, 2015; Haegele & Porretta, 2015). Because youth with visual impairments tend not to regularly engage in physical activity, they are at risk of developing health-related issues (e.g. obesity) at a young age (Augestad & Jiang, 2015; Lieberman, Byrne, Mattern, Watt, & Fernandez-Vivo, 2010).

While it is known that youth with visual impairments tend not to regularly participate in physical activities, less is known about how youth with visual impairments experience physical activities. Typically, research focusing on physical activity for individuals with visual impairments tends to center on the opinions of parents (Perkins, Columna, Lieberman, & Bailey, 2013; Stuart, Lieberman, & Hand, 2006). Although parents of children with visual impairments report valuing physical activity (Perkins et al., 2013), they tend to be hesitant to encourage their children to be physically active (Ward, Farnsworth, Babkes-Stellino, & Perrett, 2011). This may be due to a number of perceived barriers that can impede physical activity participation, such as a fear of injury, lack of appropriate opportunities for youth to participate, poorly trained staff during physical activity opportunities, and lack of peers for children with visual impairments to participate with (Perkins et al., 2013; Stuart et al., 2006). Because of these barriers, parents are more likely to encourage youth with visual impairments to be involved in less active leisure activities than peers without visual impairments (Wolffe & Sacks, 1997).

While most research in this arena has focused on the perspectives of parents (Perkins et al., 2013; Ward et al., 2011), seldom has research explored how youth with visual impairments experience physical activity from their perspective. Listening to how youth with visual impairments perceive their physical activity experiences can provide insight into what influences them to be or not to be active. Recently, research attention has shifted to explore the perspectives of those with disabilities regarding their physical activity experiences (Haegele & Sutherland, 2015), and the qualitative paradigm has been favored in this line of inquiry as it permits in-depth explorations into participant experiences (Brantlinger, Jimenez, Klingner, Pugach, & Richardson, 2005). This research, though, tends to be limited to school-based physical education settings (Haegele, Sato, Zhu, & Avery, in press; Haegele, Zhu, & Davis, in press) and does not take leisure-time physical activity experiences into consideration. Therefore, this study looked outside of the physical education context and explored the physical activity experiences of youth with visual impairments in more general terms.

In this study, we focused on four youths with visual impairments who were born and raised in the state of Alaska, including two Native Alaskan youths. Because where people live and the culture they experience has an influence on their health, physical activity, and obesity (Myers, Denstel, & Broyles, 2016; Yang & Matthews, 2010), physical activities may have been experienced differently than other youth with visual impairments. For example, public health research often classifies neighborhoods as either “healthy” or “unhealthy” based on the availability of resources that encourages or enables healthy behaviors (e.g. healthy eating habits, physical activity) (Myers et al., 2016). Low outdoor temperatures, icy conditions, and little daylight associated with the winter months in this part of the world may reduce the number and types of opportunities for physical activity. Furthermore, Native Alaskan children, such as the Iñupiat or Cup’ik, face cultural influences that may promote or discourage different forms of physical activity. For example, a strong sense of community and family among native Alaskans (Cummins, Ireland, Resnick, & Blum, 1999) and a tendency to participate physical activities with friends/family rather than alone (Dunton, Berrigan, Ballard-Barbash, Graubard, & Atienza, 2008) may prove to facilitate physical activity experiences. Because of this, exploring the physical activity experiences of youth with visual impairments living in Alaska provides a unique perspective. Therefore, the purpose of this study was to explore the physical activity experiences of youth with visual impairments living in Alaska.

Methods

This study utilized a descriptive-qualitative methodology using an exploratory case study design (Yin, 2003). The main purpose of this case study method is to better understand complex social phenomena while retaining the holistic and meaningful particularities of real-life circumstances (Yin, 2003). Thus, an exploratory case study was deemed appropriate for exploring the physical activity experiences of Alaskan youth with visual impairments. The selected participants remained purposely small in number, in order to “provide sufficient cases for the development of meaningful points of similarity and differences between participants, but not so many that one is in danger of being overwhelmed by the amount of data generated” (Smith, Flowers, & Larkin, 2009, p. 51).

Participants

A convenience sample of Alaskan youth with visual impairments (including blindness), recruited during a developmental sports camp for individuals with visual impairments located in Anchorage, Alaska, acted as participants who voluntarily joined this study. All participants were full-time residents and attended public schools in the state of Alaska. In the logic of maximum variation (Patton, 2002), we sampled a diverse group of youth including those living in different communities (e.g. suburban, urban, Alaskan village) and from different cultural backgrounds (e.g. Native Alaskans). Prior to data collection, parental consent and participant assent were obtained for each participant, agreeing to participate in the study. Pseudonyms have been used to protect the participants’ identities.

Agloolik

Agloolik was 12 years old at the time of the interview and identified himself as a native Alaskan (Iñupiat) male. He was born and continues to live in a large native Alaskan village located on the northern, arctic coast of Alaska. Agloolik’s visual impairment was caused by septo-optic dysplasia, a rare disorder which is characterized by optic nerve hypoplasia and pituitary hormone abnormalities (Webb & Dattani, 2010). He has minimal light perception in both eyes and uses a long cane for a mobility device.

Everett

Everett was 17 years old and identified himself as a Caucasian male. He was born and continues to reside in a small suburban area, located approximately 40 miles north of the largest city in Alaska. His visual impairment was caused by optic atrophy and his visual acuity is approximately 20/400 in his left eye and 20/250 in his right eye.

Jewell

Jewell was 18 years old and identified herself as a native Alaskan (Cup’ik) female. She was born and continues to live in a small, rural village on the west coast of Alaska. Her village is located close to the Yukon River, and she describes it as “not having any trees, but plenty of land and bushes with berries.” Her visual impairment was caused by retinitis pigmentosa, and her visual acuity at the time of the interview was 20/200.

Vernon

Vernon was also 18 years old at the time of the interview and described himself as Asian-American male. He was born in Taiwan, but was raised (beginning in grade school) in the largest city in Alaska. Vernon has no light perception in either eye and lost his vision due to complications associated with a premature birth.

Data collection

Data were collected during a developmental sports camp for individuals with visual impairments during the summer of 2016. Data collection included semi-structured interviews (including a demographic questionnaire), reflective interview notes, and observational notes. The researchers’ university institutional review board reviewed and approved all study protocols.

Interviews

The primary source of data were semi-structured, audio-taped face-to-face interviews completed by the second author (A.Y.). Interviews took place in the evening after all activities were complete, in a private setting. Each completed interview ranged from 45 to 60 min in length and assumed a conversational tone.

Each interview began with the interviewer describing the purpose of the study, as well as her background in order to expose her relationship with participant group (i.e. researcher positionality). The interviewer explicitly stated that she (a) was a graduate student interested in adapted physical education, (b) had no previous experience teaching youth with visual impairments prior to volunteering at the camp, and (c) was a Caucasian female who does not experience disability. Semi-structured interviews followed an interview guide which was developed to ensure that similar lines of inquiry were pursued across participants (Patton, 2002). Prior to data collection, a drafted version of the guide and the research questions were distributed to a panel of colleagues who had previous experience conducting research in this arena, to ensure relevancy. The guide was revised based on feedback from the panel and was finalized after agreement was received regarding the guide prompts. Questions remained purposely broad and focused on the participants’ experiences in physical activity and how these experiences impacted them. Sample questions included the following: (a) Can you describe what kinds of physical activity/exercise you participate in? (b) Do you enjoy physical activity/exercise? and (c) What do you like most about physical activity/exercise?

Reflective interview notes

During and immediately following each interview, the interviewer recorded reflective interview notes. Reflective interview notes included the interviewer’s reflections on what the participant said, initial feelings about the conversation, and preliminary thoughts about possible emerging themes. Immediately following each interview, the interviewer (A.Y.) and first author (J.A.H.) discussed the interviews further, and notes from these conversations were also included in the reflective interview notes. The reflective interview notes allowed the researchers to reflect critically on themselves and note personal values that could have affected data collection and interpretation (i.e. ensure reflexivity; Walker, Read, & Priest, 2013) and control for other various interview effects (Fraenkel, Wallen, & Hyun, 2012).

Observational notes

Throughout the course of the developmental sports camp, J.A.H. and A.Y. recorded observational notes pertaining to each participants’ engagement in various physical activities as well as casual conversations regarding physical activity participation. For example, one participant (Jewell) described how much she enjoyed several activities and wished they were available in her village throughout the year. These notes were utilized to provide additional context to the interview and reflective interview note data.

Data treatment and analysis

After the data were collected, audio-taped interviews were transcribed verbatim by the third author (T.N.K.). The objective of this process was to obtain a semantic record of the interview, where all words spoken by the interviewer and participants were recorded. After transcription, thematic development was undertaken inductively using a three-step analytic process. First, J.A.H. immersed himself into the original data by reading and re-reading the transcriptions several times to become intimate with the data. While reading and re-reading, J.A.H. marked passages he judged of interest and importance with brackets (Boeije, 2010). Second, J.A.H. reduced documents (transcripts, reflective notes, observational notes) associated with each case into emergent themes. During this process, emergent themes were identified at the case level. The final step in the analysis was to search for patterns and connections across participants through constant comparison. Reoccurring themes were identified as those that were present for all participants. After initial analysis, the researchers converged to discuss themes, and those that were agreed upon by each member of the research team were displayed as findings.

Trustworthiness

Trustworthiness is considered the extent to which phenomena represent experiences shared by study participants (Zitomer & Goodwin, 2014). To ensure trustworthiness, a number of techniques were utilized during participant selection, data collection, and data analysis. Naturalistic transferability, the extent to which findings can be applied to others in similar contexts or situations (Patton, 2002), was enhanced in this study by selecting participants with similar experiences as Alaskan youth with visual impairments and providing abundant details about each participant. This process allows for natural comparisons to other youth with visual impairments living in Alaska. During data collection, communicative validity and triangulation were utilized to enhance trustworthiness. Communicative validity is used to ensure that the focus of interviews remain consistent and relevant to the participants’ expectations. In this study, communicative validity was established by the interviewer (a) rephrasing and asking for clarification on ambiguous descriptions of experiences and (b) beginning each interview with an explanation of the interviewer’s position in relation to the study and description of the purpose of the study. The intention of triangulation is to ensure the accuracy of data by converging multiple sources (Merriam, 1998). In this study, triangulation involved the use of multiple data sources, including semi-structured interviews and observational notes. Finally, peer debriefing (i.e. exposing oneself to a distinguished peer) was utilized during data analysis to ensure accuracy and representativeness of the data interpretation. In this study, a researcher who has experience in this arena of inquiry acted as a peer debriefer and deemed the interpretations of the data to be accurate and representative of the participants’ statements.

Results

Based on the data analysis, two interrelated themes emerged from the participant transcripts, reflective notes, and observational notes: (a) “I don’t really participate in sports other than at camp”: preferences for unstructured activities and (b) “my sister’s willing to do anything”: familial impact on physical activity. The first theme, “I don’t really participate in sports other than at camp”: preferences for unstructured activities, describes participants’ preferences for unstructured physical activities, such as hiking, walking, or fishing, rather than team sports or structured activities. Second, “my sister’s willing to do anything”: familial impact on physical activity describes the importance of family in promoting physical activity among the participants.

“I don’t really participate in sports other than at camp”: preferences for unstructured physical activity

Collectively, the participants explained that they tended not to engage in team sports or structured physical activities outside of their participation at the sports camp where data collection took place. For example, when describing his experiences with team sports outside of camp, Everett explained that

I just never did get into them. It’s [sports] not something I’m opposed to, per se, I was just never able to get into them [outside of camp]. I just never really thought it was the best use of my time.

According to Everett, team sports and other structured physical activities were not high on his priority list. This sentiment was shared across participants, where it didn’t seem important to participants for them to engage in team sports or other structured physical activities. This is particularly interesting, as the older participants in this study (Everett, Jewell, and Vernon) were leaders during the camp program and acted as mentors to younger campers (e.g. Agloolik) during team sport activities (observational notes).

Rather than participating in team sports or structured physical activities, each of the participants described their affinity for participating in various types of unstructured activities. Favored activities among participants included walking, hiking, fishing, snowmobiling, skiing, picking berries, and “rolling around in the tundra” (Jewell). For several participants, these activities were considered both fun and functional. For example, Jewell described how much fun she had exploring the tundra searching for berries, but also realized that collecting berries and fishing were important activities for her family. Similarly, Agloolik described enjoying his role within his family while fishing, which was to “hit the fish with a club” (Agloolik) after his father caught fish with a net. This phenomenon was not isolated to Native Alaskan participants, whereas Everett also described his regular physical activity as being both functional and fun. He described that because he lived outside of the main area of his town and could not drive due to his visual impairment, he would regularly walk to town from his apartment in order to “go to the grocery store or down to a fast food place to grab a bite to eat.” When asked if he enjoyed walking to town, he exclaimed “Oh, absolutely. It’s a way to get around, a way to get to stores here and there, places around town.” Like Agloolik and Jewell, Everett saw physical activity as being functional as well as fun.

It was clear that the unstructured activities which the participants engaged in were influenced by both culture and context. For example, subsistence fishing has long been a cultural tradition and economic base of Native Alaskan families and communities who occupy coastal areas (Lonner, Thorndike, Forbes, & Ashworth, 1985). Hence, it was not surprising to learn that Agloolik and Jewell both engaged in and enjoyed fishing with their families. The context of Alaska also influenced the types of physical activities that participants engaged in. For example, Jewell described numerous activities, such as building igloos, digging snow tunnels, and “rolling in the snow,” that were possible because of the icy conditions and low outdoor temperatures associated with winters living on the tundra. Likewise, it was clear to Vernon that living in Alaska provided him with unique opportunities to engage in unstructured activities that may not have been available in other contexts. He explained that

I think that living in Alaska makes me more active, because we have so many places to go to be active. We have different kinds of lakes, different trails, we were just climbing [a mountain] today. We have a lot of that around here [largest city in Alaska], so I think it helps. If I was living somewhere else, where there is not anything like what we have around here, I may not have had the same opportunities to be active.

For Vernon, he was unsure if living in other areas, particularly in the lower 48 of the United States, would afford a youth with a visual impairment with the same freedoms to be physically active as living in Alaska did.

“My sister’s willing to do anything”: familial impact on physical activity

According to Ayvazoglu, Oh, and Kozub (2006), parents and siblings can play a critical role in physical activity participation of youth with visual impairments. This familial impact was clearly explained by each of the participants in this study. For example, Vernon described that most of his physical activity participation was centered in family-based activities. He explained that

My family did a lot of hikes and stuff together, like every Saturday and Sunday. Not always hiking, but we would always try to do something, like canoeing, hiking in the summertime. In the winter, it was snowmobiling and snowboarding, those kinds of things. So, we tried to be pretty active as a family.

Vernon continued by explaining that he came from a large family, and because everyone was pretty active in his family it didn’t matter to him which of his family members he participated in activities with. Like Vernon, Jewell also described that most of her physical activity participation outside of camp was with family members. She stated that her sister was the most likely person for her to engage in activities with, because “[she]’s willing to do anything.” Jewell described that when participating in activities with her sister and other family members, they develop ideas on how to adapt activities for her together. She explained an interaction with her sister:

I have to find a different strategy than they [other family members] do, because they are fully sighted. So I tell them “I will do this with you, just help me find another way to join in.” I talk about it [the activity] with her [sister] before I even start and she’ll ask “do you want some help?” I’d say “sure, if you’re willing to help me.” Then we end up trying to figure out some ways to adapt it for me.

She continued by describing modifications they made together for a running activity “I found an empty toilet paper roll, and I put it through some rope from the end to where they [family members] wanted to stop running. Then, I could run with them and hold on to the rope.”

While Vernon and Jewell described that family enhanced their abilities to engage in physical activities, this was not always the case. When describing whether he participated in physical activities with his family, Everett (who lives with only his mother) stated that “we don’t really do much physical activity together because my mom works a 9 to 5 [job]. She doesn’t really offer it, and I don’t think about it that much.” Likewise, Agloolik explained that although he enjoys being active at the park with his parents, he does not go often because “my mom wants to do her own stuff . . . like go to the beach.” Unfortunately, he continued by stating that he was inactive while at the beach and “just stand there and do nothing” while his family relaxed. Although both Everett and Agloolik briefly discussed participating in some activities with friends, and expressed desire to engage in activities with peers more, they were more likely to participate in activities (e.g. walking, running around a park) by themselves.

Discussion and conclusion

The purpose of this study was to explore the physical activity experiences of youth with visual impairments living in Alaska. Two interrelated themes emerged from the data which explained preferences for unstructured physical activities and the importance of familial physical activity among participants. Each of the participants in this study preferred to engage in unstructured activities rather than structured or team sports. This result may not be surprising, as many of the most popular physical activities among individuals with visual impairments are individual activities, such as walking, fitness, cycling, swimming, and yoga (Jaarsma, Dekker, Koopmans, Dijkstra, & Geertzen, 2014), and are well-suited for unstructured settings. Participants’ choices to engage in unstructured activities may have also been influenced by a lack of structured or team sport opportunities for youth to participate in (Perkins et al., 2013). This lack of opportunity, for all participants in this study, may have been subjected to contextual influences (what is available in the area) as well as cultural values (what activities are valuable to the community). Because the participants were not engaged in team sports, specifically school-based team sports, they may not have had the opportunity to develop an understanding of their athletic abilities (Haegele, Zhu, et al., in press). However, within the contexts and cultures which participants in this study experienced, participating in activities which served a function to the community and/or were available in their immediate area were considered more valuable (Cummins et al., 1999).

Having support from family members is among the most important facilitators of physical activity engagement among individuals with visual impairments (Ayvazoglu et al., 2006; Jaarsma et al., 2014). This notion was shared among participants in this study as well, where several participants described the importance of participating in activities with their family members. Unfortunately, however, this was not the case for all participants, as Agloolik and Everett described experiences where family members were either unable or disinterested in engaging in activities with them. For Agloolik, in particular, a lack of activity with his parents may decrease the likelihood of him engaging in physical activities, because of the importance of participating in activities as a family or community in Native Alaskan villages (Dunton et al., 2008). Unfortunately, we did not measure habitual physical activity participation among participants in this study, so we are unable to determine the impact that these experiences had on actual physical activity participation.

There are several limitations to this study. First, this study included a relatively small (n = 4) sample size. However, the participant sample was kept purposely small in order to preserve meaningful particularities among participants (Smith et al., 2009). Second, participants were all youth with visual impairments living in Alaska. This limits the transferability of the findings of this study to a specific population. However, although this research may not be generalizable to all areas of the world, there may be other areas that are similar in some ways, providing similar lived experiences to the participants in this study. For example, Jewell’s and Agloolik’s experiences may be similar in some ways to those experienced by indigenous Russian children (Nenets) with visual impairments, who also live in communities situated on arctic tundra. Likewise, youth with visual impairments living in northern cities in mountainous areas (e.g. Reykjavik, Iceland) may have similar experiences with Vernon.

Currently, research suggests that youth with visual impairments tend to engage in less physical activity than their sighted peers (Augestad & Jiang, 2015; Haegele & Porretta, 2015). Understanding the thoughts and feelings of youth with visual impairments toward physical activity can help identify strategies to improve these experiences and promote physical activity (Coates, 2011). Results from this study suggest that when promoting physical activities to youth with visual impairments, particularly those living in Alaska, one should consider contextual and cultural influences to being physically active. As such, interventions targeting physical activity enhancement for this population should ensure that they are promoting activities that are readily available in the area in which the participants reside and that the activities are accepted and valued among community members (Cummins et al., 1999). Furthermore, results from this study demonstrate that the physical activity influences of families are essential to the promotion of physical activity among youth. Therefore, programs targeting physical activity promotion should include components which engage entire families in physical activity as a unit.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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