Several studies have explored the International Classification of Functioning, Disability and Health domains of body functions, activities, and participation to guide assessment and practice; however, only a few studies have addressed environmental factors as they relate to children and young people with disabilities. Measuring features of the environment may be critical, to promote participation and to allow children and young people to be integrated into different contexts. While some characteristics of the environment are objective and amenable to change (e.g. architectonical barriers and provision of adapted transportation), other characteristics are highly subjective (e.g. opportunities for growth in a given context). The literature shows that some of these subjective characteristics may be crucial for participation, such as support offered, and may also be critical to the perception of quality of life of children (especially young people with disabilities), such as the ability to make choices.
The instrument described by King et al. offers an innovative approach to understanding environmental factors by providing a structured framework to observe real contexts in relation to the activity. Other measures of environment that have been developed in recent years[4, 5] assess general barriers and facilitators in the environment in relation to a child/young person, but do not identify specific, context-related features of the environment in relation to performing an activity. The Measure of Environmental Qualities of Activity Settings (MEQAS) addressed this gap by identifying characteristics of the environment, not in relation to an individual's characteristics such as severity or type of disability. It is also a measure developed specifically for leisure settings and targeting young people.
A combination of three aspects may collectively be the ideal formula for a deeper understanding of environmental factors related to participation: (1) child-related challenges within a context, (2) context-related features that can support young people’s engagement, and (3) child-context barriers and facilitators. King et al. appear to have addressed the first two aspects through the MEQAS and the companion measure that is forthcoming.
The complexity of the concepts being measured and the efforts to make subjective concepts (e.g. opportunity-related qualities) into objectively observed items are challenging; however, this best represents the multifaceted nature of environmental features. The pilot testing and adaptation includes graphical descriptions of foreground/background, which may help clinicians maintain objectivity; nevertheless, many of the concepts presented, including the bottom-line definition of rating the environment with ‘young people in general in mind’, may be challenging to portray objectively. Understanding the opportunities and other features of an environmental setting independently of a child/young person may be interesting for research (in identifying supportive versus deleterious environments for participation), and program planning (in determining needs and allocating suitable resources) and may be a crucial step in considering environmental attributes related to participation interventions. It is important to consider though that in clinical practice, clinicians would most likely observe any setting with a child's limitations in mind, and that would affect application of this instrument. The authors presented psychometric testing and validation, and future studies using this measure will further clarify the objective aspects of aesthetics and affordability of an environmental setting. These attributes undoubtedly influence participation levels and can provide more enjoyable and enriching experiences for young people with disabilities engaging in leisure activities.
The MEQAS pilot testing also presented some key messages for research and practice that deserve further investigation, i.e. to include the opportunities offered in different settings and as related to activity type (e.g. group versus individual settings, physical versus passive activities). These characteristics can contribute to our understanding of how the environment can be modified to address obstacles to participation in social, active physical, and other leisure activities, and to inform program planning and policy development to endorse the types of environmental attributes that need to be modified. This measure supports recognition of the social model of disability as it relates to participation by pursuing in-depth analysis to enable the modification of environmental factors, as opposed to targeting changes at the individual level. It provides an opportunity to find beauty in environments where young people can thrive and participate fully.