Leisure for People with Disabilities in Rural Quebec

Leisure is an instrument used to facilitate the social integration of people with disabilities. However, it requires significant knowledge of the needs and expectations of this clientele, who often experience isolation, especially in rural areas. The general objective of this study was to attempt to identify and understand the realities experienced by the partners of the Quebec Association for Leisure for People with Disabilities, who offer various services and leisure activities to people with disabilities in rural Quebec. Through focus groups and semi-structured interviews with seventy local stakeholders, this study highlights the fact that the needs of organizations offering recreational activities to people with disabilities are increasingly urgent, especially in terms of finances, paratransit, accessibility, specialized human resources and consultation. This study also demonstrates that recreational activities are essential for the social and identity development of people with disabilities, but also for the development of more inclusive and connected rural communities.


Introduction
It has been scientifically proven that leisure plays a key role in the physical and mental well-being of individuals [1].This reality is even more significant for people with disabilities, who are two to three times more likely to be overweight or obese because of a more sedentary lifestyle [2].At the same time, clientele with special needs, especially those with severe limitations, generally have more difficulty developing and maintaining a social network [3].For this reason, leisure, in its broadest sense 1 , appears essential, especially for the psychological, social, mental and physical development of people with disabilities [5].However, this reality is more complex for individuals residing in rural areas due to certain financial and accessibility difficulties, unlike in urban areas, where the leisure on offer is varied and relevant.The somewhat negative economic and demographic realities that many rural communities in Quebec have experienced in recent years, coupled with various structural, financial and human obstacles, require a more active collaboration between the partners involved in order to develop a leisure offer for local populations, particularly those with disabilities [6,7].As the following studies (Garneau [8] and Edward and Matarrita-Cascante [9]) show, leisure in rural areas requires that local stakeholders work together and share skills and services.This effort should also be supported and increased by involving all the resources present (health, school services, municipalities, etc.) [10].Finally, innovation, entrepreneurship and creativity can certainly contribute to the revitalization of the rural environment by considering leisure, not as a marginal sector, but as a strategy for local, social and economic development [11].
When we take a closer look at leisure in rural areas for people with disabilities, we notice that the offer is often sparse, or even absent.Anderson and Heyne [12] as well as Dabrowski and Kuzmicki [6] note that the lack of knowledge, awareness and methods to include people with disabilities in recreational activities, along with geographical restrictions and issues with paratransit 2 [13], greatly contribute to creating barriers for their social integration.The authors add that in rural areas, most recreational programmes are segregated, whereas individuals with disabilities and their families most often want alternatives for inclusive leisure [12].Several authors point out the lack of existing, recent research that specifically addresses the cases of people with disabilities residing in rural areas, while the need for accompaniment, management, planning, etc., is blatant [9,14,15].
This study was initiated with these issues in mind, and carried out in collaboration with the Quebec Association for Leisure for People with Disabilities (AQLPH).The AQLPH is a not-for-profit organization that aims to promote leisure and its accessibility to people with disabilities of all ages throughout Quebec via its members and regional partners.Recognized by the provincial government of Quebec, this organization has proven to be the leader for many years in accessibility to leisure for people with disabilities, as well as their social and recreational participation.
The objective of this study was to monitor and try to understand the realities experienced by municipal partners, associations, as well as the communities that are part of this network and who offer different leisure services and activities to people with disabilities in rural areas in Quebec.Three specific research objectives were defined and targeted in this study: (1) Distinguish the administrative, management and action realities experienced by local stakeholders working with people with disabilities; (2) Identify the needs and expectations of local stakeholders regarding the issue of leisure, and (3) Estimate the actions of governance, consultation, communication, planning and programming, particularly the development of the leisure offer for people with disabilities.

Young People with Disabilities, Family and Leisure in a Rural Setting
In Quebec, regardless of the place of residence, 2% of children under the age of fifteen are affected by a disability [16].More specifically, these problems consist mainly of chronic health issues for children under the age of five, whereas in school-aged children, learning disabilities represent the most common disability.These disabilities have an undeniable impact on the lives of children, including significant health needs, increased health-care spending, and more difficult integration into school and child care [16].Verbal or physical abuse also affects three quarters of children between the ages of five and fourteen.In terms of their participation in leisure activities, 43% of children with disabilities in Quebec have difficulty participating in activities because of their disability on a daily basis [16].
Potvin et al. [15] also mentioned in their study that the place of leisure seems to be a determinant for young neurotypical individuals, as well as for young people with Autism spectrum disorder (ASD).They state that the level of enjoyment and satisfaction in leisure are determining factors for participation in recreational activities.In a rural setting, Potvin et al. [15] note that young neurotypical individuals 2 The term "paratransit" must be understood as a public or private transport service (bus, taxi, car, etc.) offered to people with disabilities that adapts and takes into account their disabilities.
have access to a greater diversity of activities than young people with severe ASD.A disturbing element identified in this study is that only 25% of young people with ASD participate in physical or leisure activities requiring motor skills [15].Young people with ASD appear to be primarily engaged in recreational activities alone or with their families close to home more often than their peers without disabilities [15].However, the intensity level during the activities is the same for both groups.For their part, Sheppard and Unsworth [17] demonstrated that the rural school curriculum improves the functional autonomy and leisure participation of adolescents with a moderate intellectual disability.
Through their research on young people with cerebral palsy, Shikako-Thomas et al. [18] highlighted the fact that three categories of determinants modulate the leisure participation of individuals with disabilities: personality, family, and living environment.Personality consists of characteristics such as age, gender and motor functions.Family is defined by the family's socio-economic status, level of education and social functioning.Finally, the environment consists of the physical environment (lack of equipment and structural constraints affecting leisure participation), social environment (policies, segregation, lack of information and organizations, peer support) and attitudes (intimidation, dependence on adults).This last element seems to be more prevalent in rural areas.
At the same time, there are several obstacles to participation in leisure in rural areas, namely constraints relating to physical, financial and social accessibility.In rural areas, a lack of recreational and sports infrastructure as well as a lack of leisure opportunities are obvious constraints to an active lifestyle [16,19].In the school environment, Carbonneau and Roult [20] note that schools in remote areas are less accessible both in terms of development and surface quality.Parents of young people with disabilities also perceive constraints relating to the physical environment [21].According to Law et al. [21], environmental constraints (accessibility, availability of resources, social support and equality) increase with age regardless of rural or urban location.
Accessibility constraints are particularly relevant to children and youth with disabilities.In fact, the cost of activities hinders their participation in leisure, since their household income is often lower than those without children with disabilities at home [16].This constraint is also present in rural school settings that struggle to adequately respond to the rules of financial assistance programs that can support youths with disabilities [20].
As for social constraints, Camirand et al. [16] find that the need for assistance hinders participation in leisure.At the same time, physical and sports education in rural school environments are often less present and adapted to special needs [20].However, these authors emphasize that these areas benefit from a stronger sense of mutual support between students with disabilities and those without [20].Butler and Hodge [22] observe that contacts between students with disabilities and their peers, even if they are infrequent, are pleasant, positive and respectful.They also point out that contacts are not only the result of the teacher's planning and favoring interactions, but may be the result of existing familiarity with the community [22].Still, it seems fundamental to stimulate contacts between pupils to promote inclusion.Law et al. [21] found that attitudes at home and in the community represent the constraint with the least impact on leisure participation of young people with disabilities.They also mention that these positive attitudes do not always result in more inclusive policies [21].

Adults with Disabilities and Leisure in a Rural Setting
To better understand the profile of individuals with disabilities, certain economic, psycho-social and professional parameters should be taken into consideration [16].As is the case with families of youth with disabilities in Quebec, the household income of adults with disabilities is lower than the income of people without disabilities.They are also less educated.On a psychosocial level, one quarter of adults with disabilities in Quebec experience high stress levels most of the time; the main source of stress being their health.In rural areas, the labour market is less diverse, making it more difficult for them to be hired [23,24], and in turn, very difficult for them to integrate into society.
Four main constraints to participating in leisure were noted in the literature regarding adults with disabilities living in a rural area: transportation, financial difficulties, built environment and insufficient information.According to several studies, transportation is an issue that most people with disabilities face, regardless of their age and disability [16,25,26].Mitchell [26] emphasizes that this constraint is even more prevalent for people with disabilities residing in rural areas.For this author, it seems fundamental to offer leisure activities for this clientele directly in their communities.In terms of financial constraints, there are two types: on the one hand, they affect the hiring of staff assigned to leisure [25], and on the other hand, they are linked to higher costs that are often associated to these activities [16].
Regarding constraints related to the built environment, Turcotte, Couturier and Wanet-Defalque [27] demonstrated in their study that the travel patterns of adults and seniors with visual impairments living in rural areas include car trips as a passenger, trips alone on foot, and paratransit used mainly for recreation.These authors report that due to the inadequate development of the living environments of these individuals, nearly half abandon the leisure activities they usually participate in [27].Laliberté Rudman and Durdle [28] found that for seniors with a visual disability, going for walks is different between individuals from rural and urban backgrounds.In fact, many seniors residing in rural areas claim to observe shortcomings regarding alternatives to driving, even though some have access to public transportation [28].In addition, several written reports demonstrate that communication difficulties become barriers to social participation for people with disabilities in terms of the transmission and dissemination of information and the receivers' understanding [29,30].

Theoretical Framework
This study is theoretically based on Fougeyrollas's [31] model of human development and the disability creation process.The author [32] considers that his theoretical reflection must be seen and understood as "an inclusive approach to the issues affecting people with disabilities in the wider field of the development of knowledge of the anthropological process of the production of social beings" ( [32], p. 17).His model of human development and the disability creation process is based on four central elements: (1) personal factors of the person with disabilities (skills, body, identity and social elements); (2) environmental factors (macro-society, micro-personal, meso-community); (3) lifestyle (current activities and social roles); (4) interaction and time flow.For Fougeyrollas [32], personal and environmental factors as well as lifestyle are elements in constant interaction that are influenced by a time variable that he models through the fourth element indicated above.
This model [31,32] shows that the disability arises from the interaction between the person's situation and that of the environment.It also highlights the role of individual identity factors in this process.Thus, utilizing the potential of a person with disabilities through positive support from the environment (family, school, community, etc.) would reduce disability situations and promote social participation.Fougeyrolla also highlights the time variable and the fact that the disabling situation is usually temporary.This model allows us to better understand the existing relationships between people with disabilities and their physical environment, and as a result, how their immediate and distant entourage can influence their integration into society and the burden of various disabling and frustrating situations that weigh on them.In this perspective, this model enables us to renew the reading and interpretation of the place of people with disabilities in society and the measures to be taken and put into place to facilitate their daily lives.

Materials and Methods
From a methodological point of view, this study is based on a qualitative and descriptive approach likely to reach the aforementioned research objectives.As stated by Gauthier and Bourgeois [33] as well as Fortin and Gagnon [34], this approach was chosen because it allows the description of certain situations and different phenomena by people who are more or less affected by these situations.Therefore, the analytical and reflective emphasis is placed more on the stakeholders than on specific variables.As a result, this approach allows us to go beyond the mere description of realities experienced and thus to use a comprehensive approach to the remarks made and the issues identified [34].

Data Collection Methods Used
Two methods were used for the collection of data, the first of which is the focus group.Focus groups allow us to understand how a group of participants, in this case, six or seven individuals, perceive a social problem, how they analyze it and how they discuss it [34,35].In this perspective, focus groups are likely to stimulate participants, enrich debates and allow them to reach a consensus and divergence [36].It is also important to mention that several recent studies in the field of leisure, more specifically in public leisure, were carried out using focus groups with local stakeholders [35,37,38].The second data collection method used was the semi-directed telephone interview, a choice justified by its relevant use in several other studies on people with disabilities [5,39].Moreover, as Savoie-Zajc [40] mentions, the semi-directed interview provides a "rich understanding of a phenomenon, deeply rooted in the point of view and meaning that the social stakeholders give to their reality" ( [40], p. 337).This technique allowed us to initiate a more flexible, natural discussion in which the interviewer guided the exchanges rather than controlled them.It should be noted that the focus group method was the one favored at the beginning of this study.However, due to the difficulty of bringing together different stakeholders on a specific date in some of the larger target regions, the research team decided to use semi-directed telephone interviews to contact these individuals.

Recruitment of Participants and Data Collection Methods
The recruitment of participants for this study was conducted with the help of the AQLPH network.Fifteen out of the seventeen regions in Quebec with rural areas were targeted in this study.Only the Montreal and Laval areas were not solicited due to their urban character.Each regional representative of the AQLPH in these fifteen regions was contacted to evaluate their interest in participating in this study.If the answer was positive, the representative was asked to help the research team establish a non-representative sample of eight to twelve potential participants in their region.In order to do this, and on the basis of several methodological studies in this domain by Fortin and Gagnon [34], Gauthier and Bourgeois [33], and Veal [35], different criteria were chosen for the recruitment of participants, who had to meet the following requirements: (1) Work in a municipality or rural community as defined in Quebec (fewer than 10,000 inhabitants in a rural area); (2) Represent a partner organization of the AQLPH regional network; and (3) Work directly with people with disabilities or support initiatives directed towards individuals with disabilities.It is important to note that the research team limited the over-representation of certain participant profiles per region (for example, those from municipal sectors).In accordance with the study's objectives, the decision was made from the outset to exclude a sample from schools.The fact is that the issue of sports and recreation may be very different in schools than it is in extracurricular activities, especially regarding the supportive environment, programming strategies and communication logistics [16,20].
Once a list of participants had been established by the regional AQLPH representative, these individuals were invited to a two-hour focus group that took place at a central location in their region (usually at the regional AQLPH office).Each group was led by a member of the research team accompanied by someone who took notes and handled the logistics of the focus group.If fewer than five people per region were available to participate in the planned focus group, semi-directed telephone interviews were conducted by two research team members with an average duration of thirty minutes.For analysis purposes, focus groups and interviews were recorded with the consent of participants.As such, this study was approved by the Research Ethics Committee of the university's research team.

Sample and Subjects Discussed
A total of twelve regions were studied between 1 February and 17 June 2016.Only three regions did not participate in this study, not because of a lack of interest, but because it was difficult for the regional representative to find time to recruit participants or to get in touch with them.Of the twelve regions, five were analyzed using focus groups, while the others were analyzed using semi-directed interviews.Thirty-seven telephone interviews were conducted.A total of seventy participants took part in the study.
These focus groups and semi-structured interviews were conducted using a discussion guide structured around seven themes and twenty-five open-ended questions.Topics included: (1) Introduction of each participant; (2) Socio-demographic and economic particularities of the area covered; (3) Current issues in the area/region regarding leisure activities for people with disabilities; (4) Key challenges in supporting satisfactory rural recreation for people with disabilities; (5) Impacts/effects (positive and negative) of recreational activities on people with disabilities; (6) Overall knowledge of individuals with disabilities; and (7) Discussions about good ideas, best practices, and new and inspiring initiatives established in the area/region regarding the issue of leisure for people with disabilities.However, it is important to indicate that due to the large volume and variety of data collected, only the results from Themes (1), ( 3), ( 4), ( 5) and ( 6) were used for the purposes of this article.

Data Analysis
The data was analyzed using NVivo software and based on protocols by Paillé and Mucchielli [41].Beyond the construction of a coding tree, this computerized analysis enabled us to group and categorize the main results to obtain an overall picture of the data by type of respondent and analytical themes.However, the analysis by type of respondent did not reveal significant differences in views.A varied sample of respondents was analyzed from this angle, and the results were homogeneous.Therefore, the results presented are based only on a thematic analysis.It should also be noted that the first phase of processing this qualitative data (global grouping and categorization) was carried out by a member of the research team.Following this phase, two other researchers began to read and separately analyse this phase in order to establish themes, especially specific sub-themes.Thus, both researchers established their own analysis without consulting each other, while highlighting the themes and sub-themes they were targeting.In the second stage, pooling was carried out, which produced a different analytical consensus.This analysis technique helped minimize the interpretive bias and reinforced the objectivity of the results presented.

Participant Profiles
A total of twelve regions in Quebec were analyzed during this study and seventy people participated in this research project.The global sample obtained contained fifty-four women and sixteen men from the following sectors: municipal (n = 31), volunteers and community (n = 28), regional (n = 7), health services (n = 3) and teachers at the college (Cégep) level (n = 1).These participants were professionals (n = 34), directors (n = 24), recreation technicians (n = 5), presidents of associations (n = 2), volunteers (n = 2), an administrative assistant (n = 1), teacher (n = 1) and trainee (n = 1).These individuals had an average of eight years of experience.During data collection, all age groups that make up the population of people with disabilities (children, adolescents, adults and seniors) as well as all major types of disabilities (Autism spectrum disorder (ASD), language impairment, intellectual disability, motor impairment, visual and hearing impairment), with the exception of severe mental health disabilities, were identified and discussed.

Current Challenges and Issues Relating to the Recreational Offer for People with Disabilities
The various participants were asked to discuss the challenges and other issues they believe are key to establishing leisure facilities for people with disabilities.These individuals agreed that financial considerations, paratransit, accessibility to recreational spaces and facilities, availability of specialized human resources and finally, considerations specific to consultation between local stakeholders are pivotal when addressing this issue.
In terms of financial considerations, not all respondents wish to receive more money directly paid to their organization.Instead, they believe that more substantial grants should be given to the stakeholders involved to develop paratransit, increase the accessibility of physical environments and support certain families.As such, a professional stated: "Here, we have support, but we created a committee for paratransit in order to put pressure on the government so that paratransit receives more grants." At the same time, the individuals interviewed, who wish to obtain more financial support specifically for their organization, mainly criticized the lack of internal qualified human resources and a recurring difficulty in offering varied recreational programming.A representative of an association said: "With underfunding, it is an issue because we do our best to offer activities and absorb most of the costs because we want them (people with disabilities) to have fun, diversified experiences, allow them to leave the house.And then we find ourselves stuck because financially, we cannot manage everything and pay the employees." We note that the issue of paratransit, which is offered according to a regular schedule, but also for occasional activities, appears problematic in most of the environments studied.For these stakeholders, this is a key issue because of the geographical features of their territories (long distances between villages and communities).The senior manager of an association offering recreational activities for people with disabilities mentioned: "Distance and paratransit certainly complicate the organization of leisure and the offer of leisure services.Because whether we want it or not, the further we go, the higher the transportation costs.Whether it be for the people who help us, or for us when we have an outing . . .The costs are there, so at some point, it has an impact on what I can and can't offer." According to participants, it is fundamental to offer paratransit that is more flexible in its management structure and more focused on their needs.Some stakeholders even suggest exploring alternative avenues to complement traditional paratransit services (purchasing an adapted mini bus with several other municipalities, agreements between parents, and the creation of a bank of people with adapted vehicles).To this end, a professional stated: "I lived in New Zealand several years ago and over there, I didn't see that here at all, but people who have adapted vehicles, . . .at one point they got together and said, I have an adapted vehicle, I have another, and they got collective insurance together, and those people are ready to lend their vehicle.And then there's like a bank of people who can volunteer to transport people with disabilities."Beyond this key issue, participants also raised the issue of the accessibility of spaces and recreational facilities.This non-accessibility or partial accessibility is mainly physical and geographical rather than economic.Indeed, most stakeholders deplore the excessively long travel times to certain specialized leisure facilities (arenas, libraries, cinemas, etc.) and on-site facilities that do not allow the person with disabilities to travel easily.A professional indicated: "We go through this a lot.People who come from the ends of the territory, they have to leave at 6:30 in the morning and return at 5:00 in the evening.And our activities are offered from 10:00 a.m. to 3:00 p.m. because these are the hours when people with disabilities can actively participate.What do we do before and after, we don't have personnel, we don't have employees to keep them busy between these two periods, so people with disabilities find themselves moving around and not having services."However, these interviewees are aware that they operate in settings where the available financial resources to adapt these physical spaces are limited, as compared to certain urban areas that are better equipped.Nevertheless, several participants said that some new public or private buildings do not consider or only somewhat consider the needs of people with disabilities or that some of the existing leisure areas could be made more accessible without necessarily undertaking major work.To this end, a professional mentioned a specific example: "When we put up the swings (adapted with sand all around), the person in charge of the construction told me that the parent will take the child in their arms and bring the child there (on the swing).Yeah, yeah, I can do that.I'll take him in my arms to put him there.But when Grandma comes or even mum or even a dad who's not as strong, I don't know, they won't take the child in the chair to bring him there, you know." In addition to this issue of universal accessibility, almost all participants disapproved of the lack of variety of adapted equipment available on their territories, and brought up a few examples (cinemas, outdoor trails, arenas, restaurants, etc.).According to some stakeholders, this situation causes some frustration among different people with disabilities.
From this point of view, when participants were asked whether these issues of paratransit and accessibility are the result of poor or low awareness among elected representatives or even the general population of the realities of people with disabilities, they all disagreed.According to them, people with disabilities are generally well accepted in their communities and very few explicit stigmatization phenomena are observed, especially by elected officials who are aware of certain cases of jurisprudence in this area (particularly with regard to day camps).A director explained: "Now, whether it be for people with disabilities or for any other differences within the population, I think we still have ways to go, but more and more people accept differences, be it disabilities, religion, sexual orientation.As I said, there is still a way to go, but there is progress, and I think that we no longer see anyone laughing at people with disabilities."Many interviewees believe that the limited human and economic resources in their territories combined with significant distances between communities require public decision makers to sometimes make trivial decisions for people with disabilities.In this context, the role of these stakeholders in the leisure world must be more closely tied to representational efforts than to true awareness.A professional said: "The awareness we talked about earlier (among elected officials) is important.They are often older officials or officials who may have less experience in politics and administration, so we have to foster awareness."Many interviewees also criticized the lack of trained and specialized human resources to accommodate people with disabilities in recreational activities.These stakeholders must often turn to student trainees or volunteers to meet their specific needs.On that point, a director stated: "We had to develop a working mechanism with a (local specialized) organization because I always wanted to make sure that the social workers of this organization were with us (to welcome young people with disabilities).Because I couldn't put the entire workload on the students who work in the days camps.The workload is too much."However, this workforce proves to be very mobile and it is not always easy to retain these individuals, for various reasons (someone starting their career, an individual hired for contract work tied to specific grants, senior volunteers who are less and less available, etc.).This situation, which is sometimes very problematic in certain environments studied, places tremendous pressure on organizations that must accommodate people with disabilities.In this context, the ratio of people with disabilities to people who accompany them is rarely optimal and does not make it possible to integrate them into "regular" groups or leisure activities.To this end, a professional explained: "Of course, a lack of (specialized) human resources is problematic, and can be a reason to actually refuse a young person (with disabilities), because if we don't have the possibility of having an additional (specialized) resource, it also becomes an obstacle for our leisure offer." This human resource challenge also raises the issue of volunteers, who, according to many participants, are increasingly difficult to recruit, but also difficult to retain because of demographic considerations (ageing population), and financial considerations (not enough money to travel regularly to leisure activities).
Finally, a major issue identified by almost all participants is the consultation between local stakeholders working with people with disabilities.Indeed, the individuals interviewed agreed that the economic and geographical realities of their environments require working in partnerships, but that these are sometimes difficult to implement because of a deeply rooted culture of "working in silos", a lack of knowledge of existing methods outside their sphere of intervention, and "turf wars" between certain municipalities.Several participants reported on several innovative local initiatives that were set up as a result of partnerships, but they agree that this logic of exchanges and consultation needs to be further developed.A director mentioned: "We started a programme called the navigator programme, because we realized that the clientele (with disabilities) very often become attached to an organization when they join and after, it is difficult to refer them to another place.(With this programme) we wanted to somehow undo these silos because individuals (with disabilities) will look to meet their needs in a specific place that is not necessarily the one that best meets their needs.So, our navigator programme has a worker who meets with association and community workers from different backgrounds to ensure that there is a real connection between them and that they are able to refer the individual with disabilities to the right environments and resources." In a complementary way, most participants felt that these partnerships and the resulting actions must be created with and for people with disabilities and their families.Several stakeholders gave the example of intervention plans developed in schools with different health professionals that are only partially shared or not shared at all with day camp managers.This problematic situation in terms of welcoming young people with disabilities calls for improved communication and collaboration between municipal, school, and health stakeholders as well as parents.In addition, other interviewees believe that the growth of various aspects of these partnerships (paratransit, leisure offer, information and communication, etc.), should make it possible to reach certain people with disabilities, often adults and seniors, who are more isolated geographically and economically.As such, a director summarized this issue of consultation and partnership: "It's obvious when you're part of the municipal sector.We have an obligation to ensure that we offer services that correspond to the entire population.But financial resources being limited, if we take the day camp example again, sometimes children require individual support.Financially, I can't offer an educator per child thirty-seven hours a week.We do not have the financial means to be able to offer this, but in conjunction with an organization in the region, in partnership, we can find solutions to meet these needs.The challenges at this level are really to know each other more, to understand each other better, to speak and to be well equipped to meet the needs all together."

Effects and Benefits of Leisure for People with Disabilities
When we talked with participants about the effects of leisure activities on people with disabilities, all of them agreed that recreational activities undeniably provide benefits for people with disabilities.The analysis shows that interviewees mentioned three main types of benefits: (1) benefits for the person with disabilities; (2) benefits for the relationship between the person with disabilities and his or her social environment; (3) benefits for the family and relatives of the person with disabilities.
Regarding this first type of benefit, almost all participants stated that regular leisure activities improve the physical health, confidence, self-esteem and mood of people with disabilities.As such, a general manager of an association added: "Yes, recreation is important to them because I'd say it's a big part of their lives.And it's good for self-esteem, trust, just having a sense of belonging, breaking down isolation, it's all super important." Many stakeholders also mentioned that people with disabilities feel rewarded when participating in these activities, especially if they provide them with a certain sense of autonomy.Unanimously, leisure in all its forms allows true personal fulfilment for these individuals with disabilities, one that is generally accompanied by a certain level of enjoyment.Another senior manager said: "We work a lot (on) leisure activities that develop mutual help.We rely heavily on the autonomy of each person, so that if the person gains confidence in his or her personal autonomy, there is a chance that they can act more easily in their environment, which encourages their self-empowerment." Several participants also indicated that it is important to regularly renew the activities offered to individuals with disabilities to allow them to discover and thus introduce them to new recreational activities for purposes of creating unique experiences for them.Nevertheless, these stakeholders recall that for these activities to make sense to individuals with disabilities, they must be suggested and thought of by and for them, particularly when dealing with an adult clientele.As such, the stakeholders interviewed who work with adults with disabilities report that leisure of a more social nature (going to a restaurant or a cinema, shopping or having coffee) seems to be very significant and has many benefits for this clientele.As such, a senior manager expressed the following: "Social participation becomes more and more important because now, they are adults and want to do like everyone else.I want to have an apartment, I want to have a job, I want a girlfriend, I want to have friends.They really want to be like everyone else, so going out to restaurants, going out . . .and not just with people with disabilities, (they want) to be among other people.Going to the cinema, but not with a flashy red sweater, because they want to go there as a person and not as a group, we see that a lot."I want to do like everybody else" is really important." Overall, participants agreed that participating in recreational activities is beneficial to the physical and mental health of these populations with disabilities, regardless of age or disability.However, it is noted only in some environments studied that there appears to be a "service gap" for adults with disabilities aged 20 and over.Indeed, the latter often appear to be isolated or even very socially isolated, especially if their disability is severe, and their opportunities to participate in recreational activities are generally due to their own efforts, the efforts of their families, and the presence of community and voluntary organizations for adult clients in their communities.A professional stated: "There is a service gap; I think of XX (name of a person with a disability), who's in a wheelchair.He is a natural leader, he said to himself, I'm going to take charge and start my own (sports) league; I'll find money for wheelchairs and to initiate people.But at the primary school level, you have a social network with the school and medical sector that often accompanies you, or the special education teacher who accompanies you or gives you tricks, and we will sign up the child for skating to stimulate the child, who will pursue their academic journey.But once (the young person with disabilities) finishes secondary school, there is a really big service gap in terms of integration into employment versus leisure.Where is the 20-year-old with autism, who has difficulties, where does he or she fit into the recreational programme?Not all organizations can welcome a young person older than say, 20 years old." Regarding the second type of benefit, many stakeholders interviewed note that leisure activities for people with disabilities, when carried out in an inclusive perspective, greatly contribute to reinforcing their social relations with neurotypical individuals, and even break down certain forms of social isolation they experience.At the same time, according to most participants, these exchanges created or stimulated by leisure contribute to informing neurotypical individuals of the realities and needs of people with disabilities.To this end, a professional observed that: "With the example of the interaction activity that I set up . . .young people (with disabilities) were integrated into a mixed group (in a targeted sport).Well, after that, the coaches' response was, well I didn't think it would work so well, and it even helped break down barriers a little (between people with disabilities and neurotypical individuals)." Finally, in terms of the third type of benefit, most participants said that seeing people with disabilities flourish, be self-sufficient and enjoy leisure time is an enormous source of pride and joy for their families.Several stakeholders mentioned that the family circles of these individuals with disabilities experience a lot of stress on a daily basis to support them, and that the fact that certain recreational activities generate positive impacts on their children also provides them with a certain sense of well-being.In addition, a few participants with considerable experience in the field observed that some parents had more and more confidence in their children when they saw them become autonomous in carrying out certain daily tasks (getting their sports bag ready, making certain culinary recipes, doing the groceries, etc.), thanks in part to their regular participation in leisure activities.A professional mentioned a young person with Down syndrome who was integrated into a swimming team: "The mother said to me, he takes care of his bag, he takes care of his things for the pool on his own, which he didn't use to do, well, before he wasn't on the team, but meaning that before, he didn't pick up his things and take care of his things, and the training developed his autonomy because he is treated like the other swimmers." At the same time, most interviewees pointed out that the fact that a person with disabilities regularly participates in recreational activities allows his or her family to enjoy some time to relax and thus strengthens the cohesion of the family unit.As such, a senior manager spoke to this point: "It provides respite for natural families.Offering leisure to their children is a roundabout way of providing respite to the parents because no later than yesterday, a mother dropped off her teenager for an activity, and when she left, she said, 'I'm on my way, my boyfriend is waiting for me for dinner, dinner just the two of us is going to be nice.'For me, that speaks for itself."

Knowledge of the Clientele Served and Training and Communication Needs
Overall, respondents seemed to identify a lack of knowledge, sometimes very precisely, about clientele with special needs, as well as the strategies to integrate them adequately into recreational activities.This knowledge could possibly be conveyed to them through distance learning tools as well as various opportunities for exchange.
However, it is interesting to note that the stakeholders working at the municipal level seem to have the greatest need for information to better accommodate and integrate people with disabilities into recreational activities.This reality seems to be mostly experienced by those with the least experience or by those working in small municipalities.Moreover, it is noted that this lack of knowledge mainly manifests itself vis-à-vis individuals with cognitive limitations (mainly Autism Spectrum Disorder-ASD) rather than a physical disability.On the subject of knowledge and other information that these stakeholders would like to obtain, the analyses carried out showed that they would like to better understand these disabilities (definition, behaviour, medication, etc.), what they represent in terms of intervention and support (intervention plans, forms of support to be prioritized, crisis management, etc.), and what leisure can do for these individuals with disabilities (impacts, types of leisure to be prioritized, materials required, etc.).Some participants also mentioned a need to acquire knowledge to better communicate with the family environment of people with disabilities.To this end, a technician reported the following: "You know, in rural areas, we also have the reality of children who have special needs in school but who are not (educated) in their environment.They (parents) send them to specialized schools, wherever the schools are located.And in the summer, they send them back to us (the municipal day camps), they come back to us with camp counsellors who are 16-18 years old at the most.First, we haven't seen the children, we don't know their needs.The children arrive, don't have friends, are not integrated, and the counsellors don't know them either.They (parents) send them to a specialized school with people who are trained and here, we have someone (counsellor) who is in secondary 4 with their first job."When all participants were invited to discuss the training strategies and the means of communication to be favored to improve how they deal with clienteles with disabilities, almost all agreed on two points: (1) develop distance learning tools; and (2) increase opportunities for exchanges with other stakeholders in their region.Regarding the first point, most stakeholders interviewed already use or regularly consult online information documents, webinars and other videos to learn about the integration and accompaniment of people with disabilities in leisure.However, many would like certain tools to be better adapted to the realities of rural environments and to the characteristics of the individuals they work with.In this regard, a director explained: "It might be interesting (about distance learning tools).Of course, we are in a more remote area, farther away, because I know that there are meetings sometimes at the provincial level, but we do not necessarily participate because of a lack of time and resources.On the other hand, if they (those who developed these tools) moved around and organized days for awareness, discussions, exchanges, then I would say that the stakeholders in the territory here work together a lot.Last time they came, there were like 150 people who came to meet them.So then, it's more interesting for stakeholders." At the same time, some participants mentioned that they would like to be approached directly by a regional head of the field (responsible for current awareness and training) about these e-learning opportunities instead of having to sign up for various newsletters or responding to various emails without knowing whether these items are relevant to them.As such, a technician observed: "I think training has more to do with our needs.On a case-by-case basis.I would rather have a person in charge that I can contact and say, I have a young person who is going through this, how can we deal with it, how can we integrate the person?That way, I can really refer to a resource person who has the information." Regarding the second point raised by participants, they felt it was essential for them to exchange regularly (once a month ideally or at least once every two months) with other colleagues in their region and some stakeholders from other sectors on different issues they are experiencing.A senior manager said: "There are certainly some events that make roundtables a little more difficult sometimes, but it's still important because they are lively and you know, we have this opportunity to have an open partnership with all the stakeholders, be it the health network, education network, community organizations, and we can speak to one another and tell it like it is, which is very valuable, although sometimes we have small personal battles to overcome.But the fact remains that we can see each other, talk and work together and work on projects that will bring a lot to the region." Most interviewees already participate in these meetings, but would like to see their structure improved in some cases (planned according to a yearly schedule, themes for each meeting planned ahead of time all the while allowing the possibility of adding more spontaneous discussion elements, the presence of a wider variety of stakeholders at the table, inviting experts on the issues debated, etc.) and enable more concrete actions to be taken on the ground.
Finally, we note that almost all participants are satisfied with the exchanges and the support offered by their regional representatives of the AQLPH.However, this result should be considered with some restraint since each stakeholder interviewed was informed that this study was conducted in partnership with the AQLPH.This may have led to a social desirability bias between the facilitator/interviewer and the participant.

Discussion and Conclusions
This qualitative study, which focuses on local stakeholders working with people with disabilities residing in rural areas in Quebec, highlights several findings that correspond to the literature regarding this subject.All participants in this study agreed that leisure occupies an important place in the lives of people with disabilities and greatly affects their physical and social development.However, for these recreational activities to positively contribute to the well-being of individuals with disabilities, the proposed support must be adapted to their needs.Indeed, most stakeholders interviewed consider that the support offered to people with disabilities should often be adapted on a case-by-case basis according to different individual specificities (type of disability, age, health status, medication, etc.) to enable them to thrive and enjoy themselves during leisure, but also to increase their level of independence.This is in line with Bullock and Mahon's [42] model of leisure accessibility, which leads us to consider the profiles of people with disabilities as well as their needs and expectations in terms of leisure to adapt the offer to their abilities and skills.The key idea here is to avoid creating new frustrations and additional obstacles for people with disabilities when they are invited to engage in leisure activities.
Moreover, the stakeholders interviewed also pointed out that people with disabilities are no different from neurotypical individuals in terms of recreational planning and programming.They want to take part in activities that suit their interests and values while occasionally looking to experiment with new leisure activities.These elements coincide with Fougeyrollas's systemic theoretical reflection [31,32], in which he recalls the importance of not viewing people with disabilities as different from the rest of the population, but rather as an inclusive collective "whole".In the analytical context that concerns us, the attachment of the micro (personal, proximal and domestic) to the meso (community environment) and macro (societal environment) is what interests us and challenges us based on the results obtained (Fougeyrolla [31]).These conclusions are consistent with Bullock and Mahon's [42] conceptual principles regarding recreational services offered to people with disabilities.In fact, for these authors, considering, acting and evolving with a person with disabilities in a leisure context involves mobilizing and interpreting this person's action through three elements: (1) social role valorization focused on the individual's social image and the reinforcement of his or her skills; (2) self-determination around motivational construct and autonomy; (3) interdependence with mutual acceptance between individuals with and without disabilities, and societal inclusion [42].
More fundamentally, the description of leisure activities proposed and practiced by people with disabilities supports Pronovost's [4] normative foundations of leisure.Indeed, this author sociologically interprets the leisure object through four social standards that are clearly distinguished in the results obtained.Pronovost [4] considers that there are standards of action for acts, occupations and behaviours; standards of involvement (minimum distancing with customary activities); standards of interaction (social relationships and interactions generated from an integration perspective); and finally, contextual standards related to the practice area and space as well as to atmospheres and temporalities.This normative spectrum emerges in the comments made by the interviewees and demonstrates to what extent leisure is rooted in social and community dynamics that are essential to its maintenance and legitimacy for people with disabilities.This research also highlights the fact that the challenges and issues identified by participants in this study appear to be mostly linked to partnership, planning, programming and inclusion considerations.This analytical finding corresponds to the results of Mitchell [26], Collet-Klingenberg and Kolb [25], and Camirand et al. [16] regarding the issues of transportation, specialized human resources and recreational programming.These elements prove to be central for many of the people interviewed, who are concerned with being able to maintain a leisure offer that is adapted and stimulating for clients with special needs.Although not all respondents made this observation, there seems to be a certain duality in the leisure offer between, on the one hand, an adapted (more or less varied) leisure offer consistently proposed to children and young teenagers with disabilities, and on the other hand, a fairly limited or even non-existent offer for young adults with disabilities.This is consistent with the views of Walker et al. [13] on the presence of this "service gap", but also those of Law et al. [21], who consider that different types of constraints, especially environmental constraints, increase with the age of people with disabilities.
At the same time, our research demonstrates that there seem to be three situational and interventional spheres when dealing with the issue of leisure for people with disabilities.These three spheres appear concomitant and must be considered in a global logic to better understand the nuances of these realities and territorial, economic, political, social and cultural stakes.First, the individual sphere concerning the physical and social characteristics of the person with disabilities and his or her interests, needs, and other recreational motivations, appears central to this interventionist logic.As for the family sphere, which is composed of the parental cell, but also the rest of the family and friends of the person with disabilities, is essential in understanding the modalities of integration and involvement through leisure of the person with disabilities in his or her rural community.Finally, the environmental sphere, which combines physical and built elements as well as elements of a more social and economic nature, is fundamental and must be identified and considered in order to understand the dynamics in these rural territories.This analysis reflects the findings of Shikako-Thomas et al. [18], which focused on young people with cerebral palsy, particularly in terms of family and environmental components.Participants who took part in this study were very concerned with increasing the number of exchanges between people with disabilities and the rest of their communities to increase social inclusion, participation and mobilization, but also for the recognition and legitimization of the rights of people with disabilities.This interpretation is in line with the studies of Law et al. [21], and Butler and Hodge [22] on the place and role of the community in the inclusion process of individuals with disabilities and on the need to turn certain citizen actions into real policies.At the same time, the key role of the family in these inclusion strategies can be related to the reflection proposed by Dattilo [43], who considers that any recreational service working with clients with special needs should seek to establish healthy and viable relationships with their family members.For this author, this type of social and partnership collaboration can truly "break down" barriers and make it possible to improve the leisure offer for people with disabilities [43].Finally, we observe that introducing inclusive recreational activities (mixed group of people with disabilities and neurotypical individuals) seems to have many social benefits on participants.This is consistent with Schleien et al. [44], who see these inclusive practices and principles as possibilities to put in place processes of social value and cohesion.They believe that these inclusive forms of recreation are essential to create and ensure a place for people with disabilities in their communities [44].
Also from this perspective, we find that all the results obtained correspond to the definition of an inclusive community by Bullock and Mahon [42], based on Berman's studies.For them, an effective community requires the recognition and maintenance of different principles, in the sense that it offers opportunities for development and fulfillment for everyone, namely: • "Acknowledging their connection and commonalties; • Experiencing a sense of belonging; • Respecting differences; • Developing relationships; • Sharing the responsibility for decision-making; • Having a common purpose or shared vision ( [42], p. 368)."Thus, the concept of an inclusive community leads to the development of a "living together" based on respect, mutual help and above all, recognition of the value of each individual in a collective "whole", despite more or less visible differences.
This analysis and reflection allow us to offer possible intervention strategies that could enrich discussions on this issue of leisure in rural Quebec for people with disabilities.In order to make these strategies easier to navigate, we have chosen to present them in an enumerative way: Adapt training material on leisure for people with disabilities to the realities of stakeholders working in rural areas as much as possible.
Of these possible intervention strategies, which derive directly from the results obtained and interpretive analyses correlated, we provide certain criticism and even express reservations regarding these elements.Indeed, the challenges and needs mentioned by the participants in this research are significant and call for the review of important management and financing processes in rural Quebec.The resulting rural exodus from rural areas in Canada, which is intimately linked to latent economic devitalization [7], requires local stakeholders to develop intermunicipal agreements that can contribute to maintaining different citizen services, in which leisure is a central element [45].However, as Garneau [8] clearly states, implementing this type of agreement is most often linked to a trigger that has significant impacts in the affected communities (new policy or regulation, one-time event, management "shift" by other major municipalities, etc.).In this context, it is not necessarily dialogue and regular exchanges between the local stakeholders that lead to these changes but rather a real mobilization process led by local leaders and likely to raise the awareness of the elected officials to the issues experienced.This is slightly evident in our results, but the stakeholders interviewed seem to be so absorbed and caught up in everyday situations and problems to be managed that one wonders if they have enough time and energy to trigger this type of citizen and community governance process.This role should come more from the AQLPH.In recent months, this national association has been working hard with the provincial government to make the benefits of these local stakeholders on the well-being of people with disabilities more well-known and at the same time, to obtain more substantial financial support.This is long-term work that is subject to political uncertainties and the goodwill of elected officials, who nevertheless seem to understand the people interviewed in this research.
Finally, it is important to identify the study's various methodological limits.First, the qualitative nature of this study does not allow for us to generalize the results obtained.However, the level of saturation of certain articles reviewed leads us to think that our results demonstrate a certain social representativity.Although several rules and other methodological considerations were taken into account, the facilitators and interviewers of the focus groups and interviews carried out were able to discern certain biases.It is undeniable that different biases of social desirability may have emanated from various statements by participants.At the same time, three regions with rural areas were not analyzed during this study.Focus groups or interviews with stakeholders in these areas could have qualified or reinforced some of the results obtained.
Increase the physical and geographical accessibility of spaces and leisure facilities for people with disabilities; O Increase the variety of leisure activities available to people with disabilities; O Adopt more flexible and adaptable transportation management and reservation modes; O Facilitate the hiring of specialized personnel for the supervision of individuals with disabilities during leisure activities, and jointly adopt human resources management mechanisms to retain them; O Develop and consolidate partnership agreements between sectors and stakeholders in health, education and the municipal, community and associative sectors so as to combine and coordinate efforts; O Develop a more meaningful leisure offer for young adults with disabilities; O