Inclusion as a Facilitator of Social and Physical Activity for People with Physical Disabilities

Abstract

The aim of this study was to explore the perceived relationship between inclusion and participation in social and physical activities for people with physical disabilities. In partnership with a local disability-focused non-profit organization, we completed semi-structured interviews with 12 individuals with physical disabilities. Interview transcripts were analysed using an inductive thematic approach considering the social–ecological model and quality participation framework for people with disabilities. We developed three themes to describe the relationship between inclusion and participation in social and physical activities: physical accessibility of spaces and places, advocates are needed to share knowledge, and social inclusion and social/physical activities influence each other. Participants discussed the facilitating role of social inclusion on physical and social activities and the bi-directional relationship between inclusion and community participation. Fostering social inclusion through increased accessibility, education, and awareness at the community or program level can facilitate full community participation for people with physical disabilities.

1. Introduction

At least 15% of the global population has a physical disability [1]. Physical disabilities are commonly defined to include individuals with limitations of mobility, flexibility, and/or dexterity and may require a gait aid to support activities of daily living [2]. People with physical disabilities experience higher rates of noncommunicable disease compared to the general population and are more likely to be socially disconnected and excluded from full participation in their communities due to personal and environmental barriers [3,4]. As rates of physical disability are expected to rise with the aging population [5], it is vital to understand the facilitators and barriers to community participation for persons with physical disabilities to support engagement in health-promoting behaviours.

Social relationships, community participation, and inclusion are important for overall health and wellbeing for the general population and people living with physical disabilities. People who are socially isolated or experience loneliness have increased risk of mental illness and noncommunicable disease, contributing to higher rates of mortality [6,7,8]. People with physical disabilities are vulnerable to social isolation due to deeply embedded ableist attitudes and social structures leading to substantial barriers to community participation [9]. Salient barriers to community participation for people with disabilities can be conceptualized using a social–ecological model to include individual or intrapersonal factors (e.g., knowledge, beliefs), interpersonal or social factors (e.g., discrimination or attitudes that limit feelings of inclusion) and community environmental factors (e.g., the physical accessibility of the built environment, transportation, lack of appropriate equipment) [10,11]. Factors including psychological elements (e.g., self-perception, beliefs, emotion), employment status, social support, rehabilitation processes, and health policies and systems can also significantly impact physical activity levels and opportunities for those with physical disabilities [10,11,12]. Community participation for people with disabilities must be conceptualized to include subjective experiences to capture concepts of autonomy, belongingness, challenge, engagement, mastery, and meaning [13].

The benefits of physical activity are wide-reaching and include reductions in overall mortality and general improvements to physical and mental health [14]. For people with disabilities, specific benefits of physical activity include improved muscle function and ability to engage in activities of daily living; improved mood, self-esteem, and self-efficacy; as well as decreased pain, comorbidities, chronic diseases, negative affect, and stress [15,16]. Despite established benefits, people with physical disabilities experience high rates of physical inactivity and social isolation leading to loneliness and reduced life satisfaction [17]. Like the barriers impacting opportunities for social activities and community participation, the barriers to participation in physical activity for persons with disabilities include attitudes, accessibility, access to professionals with expertise in specific conditions and varying abilities, costs and access to specialized equipment [12]. Social support from friends, family, or peers, and participating in team activities are facilitators of physical activity for those with disabilities [18,19].

Social inclusion is strongly related to physical activity in many populations and positively influences health-promoting behaviours, including physical activity [20,21,22]. Defined by the United Nations [23] as “…the process of improving the terms of participation in society, particularly for people who are disadvantaged, through enhancing opportunities, access to resources, voice and respect for rights”, social inclusion may play a powerful facilitating role in physical activity and social engagement for persons with physical disabilities.

The objective of this study was to explore how people with physical disabilities conceptualize the relationship between inclusion and participation in social and physical activities.

2. Materials and Methods

2.1. Theoretical & Conceptual Frameworks

A qualitative research method was chosen to extract the complexities of human behaviours (e.g., social and physical activities) to develop a deeper understanding of health behaviours and therapeutic interactions and capture the subjective nature of community participation [24,25]. Qualitative perspectives add a rich nuanced human dimension to understanding lived experience, integral to developing effective programs and spaces for individuals with disabilities [26].

Following an integrated knowledge translation approach, this project was conducted in partnership with Spinal Cord Injury BC (SCI BC) to ensure knowledge users’ inclusion throughout the research process in co-creating knowledge, reciprocity, shared decision making, active participation, and knowledge production [27,28]. Through a partnered research approach, the overall aim of this project was to inform the work of SCI BC to address issues of equity in opportunities for community participation. Using lessons learned in our previous work, and based on existing relationships [29,30], community partners helped to guide what research would be most relevant to them and our region, informed the interview questions, and supported contextualization of findings. Our participatory research process included meetings between the researchers (K.K., C.P.) and leaders from our community partner organization (H.L., C.B.M.) to discuss project ideas, possible research questions, and a research approach to fit within the resources available. The researchers then developed a draft project plan and re-engaged with community partners to finalize the aims and research approach. Draft interview questions were developed and reviewed by partners and piloted with knowledge users identified by SCI BC. After data collection and a draft analysis, we met with community partners to finalize our themes and discuss overall implications and findings.

Using a social–ecological lens, we situate our research within the community context and consider the interacting interpersonal, intrapersonal, and environmental influences shaping opportunities for physical and social activity [30,31]. This work was conducted in northern BC, Canada, a sparsely populated area in the provincial north, with a relatively low population density and many rural and remote communities that experience extreme winter weather (approximately November–March) [32,33]. The unique sociocultural environment of physical and social activity for people with disabilities living within the region of northern BC is distinct from urban environments [33,34]. To conceptualize social inclusion and community participation, we consider the model of quality participation by Martin Ginis et al. [13]. This model suggests that for individuals with disabilities, individual perceptions of autonomy, belongingness, challenge, engagement, mastery, and meaning best describe and can be used to conceptualize and measure participation [13].

2.2. Participants

Participants were recruited via an informational poster circulated through existing community networks. Eligible participants were between 18 and 65 years of age, self-identified as having a physical disability for a period of one year or longer, used a mobility aid to complete activities of daily living, and were able to communicate in English. Purposive sampling was used to ensure a range of experiences were included based on type of physical disability, community size, and gender [35]. Research ethics approval was obtained from the institutional research ethics board at the University of Northern British Columbia (E2020.1123.056.00). All participants provided written or verbal informed consent.

2.3. Data Generation

Data collection consisted of two components: an individual, semi-structured interview and a demographic questionnaire. The questionnaire included self-reported demographic information (i.e., age, gender) and questions about physical and social activities. Twelve semi-structured interviews were conducted by a single researcher (K.K.) on the Zoom videoconference platform (https://www.zoom.com/, accessed on 11 January 2021), audio-recorded, and transcribed verbatim. Mean interview length was 47 min (range: 32 min to 1 h 26 min). Interview questions focused on physical activity and community participation, facilitators and barriers to engagement, and inclusion (Supplementary File S1, Supplementary Materials). Prompts were used to supplement the interview guide and probe more in-depth responses. Interview questions were reviewed and piloted with community partners with lived experience of disability prior to conducting the interviews. Each participant was provided a pseudonym for anonymity.

2.4. Data Analysis

Data was analyzed using an inductive thematic approach supported with NVivo software for data organization [36]. An inductive thematic approach was used as it is appropriate for practice and community-based research, allows for reflexivity throughout the process, and is theoretically flexible to allow for consideration of multiple frameworks [37,38]. Given the complex and abstract nature of this topic and concepts, an iterative and reflexive analytical approach was necessary to discern relationships (e.g., between social inclusion and physical activity) and advance understanding [38,39]. This approach was aligned with similar collaborative (i.e., co-production) approaches to data analysis and interpretation with community partners we have previously reported [29]. Following transcription, K.K. familiarized themselves with the data and reviewed interview field notes for contextual information, making notes of ideas and patterns that addressed the research questions. Initial codes were generated from the transcripts, with consideration to codes that formed based on repeated patterns through rounds of re-reading the transcripts and identifying relevant words or phrases [37]. Preliminary themes were generated by the lead author (K.K.) by organizing themes across common ideas and patterns and then critically discussed with SCI BC community partners and co-authors to provide feedback and ensure reflexivity throughout the analysis process [39,40]. Further latent coding and theme refinement by K.W. and K.B. resulted in an understanding and definition of the different themes, their relationships, and the overall story from the data [39,40,41]. Following discussion and analytical reflection, themes were refined and finalized to focus on answering the research questions and to contribute to understanding relationships between concepts (e.g., how social inclusion influences engagement in social/physical activities). Finally, themes were collated and described in a narrative to capture the story of the data based on feedback with knowledge-user partners.

3. Results

The most common conditions reported by participants were cerebral palsy (25%) and spinal cord injury (25%). Participants reported living a range of 1.5 to 63 years with their disability (

Table 1. Participant characteristics.

Characteristic		Participants (n = 12)
Age (years)	<30	1 (8%)
	30–39	2 (17%)
	40–49	4 (33%)
	50–59	3 (25%)
	60–69	2 (17%)
Gender	Woman	6 (50%)
	Man	6 (50%)
Community population	<5000	1 (8%)
	10,000–25,000	5 (42%)
	50,000–100,000	6 (50%)
Disability	Cerebral Palsy	3 (25%)
	Spinal Cord Injury	3 (25%)
	Amputation	2 (17%)
	Multiple Sclerosis	1 (8%)
	Muscular dystrophy	1 (8%)
	Spina Bifida	1 (8%)
	Other	1 (8%)
Time with disability (years)	<10	2 (17%)
	10–19	1 (8%)
	20–29	3 (25%)
	30–39	3 (25%)
	>40	3 (25%)
Mobility aid	Power chair	7 (58%)
	Manual wheelchair	9 (75%)
	Scooter	1 (8%)
	Walker	2 (17%)
	Crutches	1 (8%)
	Prosthetic or orthotic	2 (17%)

Note: Several participants noted using more than one type of mobility aid.

). The most common mobility aid used by the participants was a manual wheelchair (75%).

We developed three main themes describing how participants conceptualize social inclusion and participation in social and physical activities: physical accessibility of spaces and places, advocates are needed to share knowledge, and social inclusion and social/physical activities influence each other (

Table 2. Themes and subthemes developed through inductive thematic analysis describing the relationship between inclusion and social and physical activities.

Theme	Subtheme	Example Codes
Physical accessibility of spaces and places	Facilities and indoor spaces	• Access to enter buildings
		• Stairs within buildings
		• Washrooms not accessible
	Outdoor spaces	• Inaccessible parking
		• Winter weather
		• Not universally accessible
	Availability of resources	• Lack of appropriate equipment
		• Cost to individual or businesses/facilities
		• Individual energy and motivation limited (e.g., fatigue)
Advocates are needed to share knowledge	Representation in organizations and programs	• Increase representation of people with disabilities in organizations as decision makers or program providers
		• Lack of organized programs for people with disability
	Education and awareness	• Businesses/facilities need education to improve accessibility
		• Sharing information with other people with disabilities
		• Education can improve attitudes
	Changing attitudes	• Fear of judgement/embarrassment
		• Individual attitudes about physical abilities
		• Advocates can be important
		• Positive attitude fosters inclusion
Social inclusion and social/physical activities influence each other	Social inclusion facilitates social/physical activity	• More social inclusion/participation leads to more programming
		• Peers share knowledge of opportunities
	Social/physical activity facilitates social inclusion	• Engaging in physical activity with others fosters feelings of inclusion
		• Team sports increase social bonding

; Figure 1).

3.1. Physical Accessibility of Spaces and Places

All participants explained that, throughout their daily lives, the accessibility of the spaces and places they visit influences their ability to participate in both social and physical activities. Inaccessibility impacts the ability to be active and access spaces and decreases the willingness and desire of individuals to participate, as Catherine explains:

Direct physical activity is hard because I have no mobility below my shoulders … there’s a lot of trails and stuff that I would still like to do, but it’s difficult to make sure the lift works anymore, so I am limited in my social interactions with my friends too, like there’s only specific places that we can go.

3.1.1. Facilities and Indoor Spaces

Many aspects of indoor spaces and facilities imposed substantial barriers to accessibility for participants. These issues included difficulties entering buildings due to stairs, heavy doors, limited appropriate parking, and difficulties within facilities such as washrooms inaccessible by wheelchairs or gait aids. Fred describes an example of this when attempting to access a facility:

The wheelchair access was in the back alley, which was a potholed kinda surface on the asphalt, but a beautiful new ramp to get into this renovated building. And the problem, when you go up the ramp in your chair, when you get to the top it isn’t an electric door … [when you] pull [the door] out, you couldn’t because you’re on a ramp. So you had to back your chair up and stretch forward as far as you could … and then there was a [significant] gap to get into the door.

To add to these issues, many business owners either refused to make changes to increase accessibility, citing a lack of financial resources, or didn’t follow through on promises to make changes. Participants suggested that buildings or facilities in development or renovation should include someone with a physical disability in the process to ensure universal community accessibility, as David explains:

I’m the only one in a wheelchair so I have the best knowledge of situations where you have to roll around into … we just discussed [ways to] make the things more accessible in our community … that would assure that it was easier to get around … I think it’s very important to be engaged in the community to help them more or less understand my point of view.

Catherine described a positive experience when raising an issue with accessible parking spaces outside a local establishment, thus enabling her participation and inclusion:

Downtown at [a social location] they have a parking spot right in front of the ramp and there’s always a truck blocking it, so I went and told them that and within three days they put up a handicap parking sign to open up that area, so that was really nice, they were super quick to respond.

3.1.2. Outdoor Spaces

Accessibility to outdoor locations was a common issue described by participants. Experiencing problems with parking, winter weather, and a general lack of accessible sites were frequently cited barriers to engagement in social or physical activities. Diane elaborates on this, explaining that these shortcomings often result in everything feeling inaccessible:

I mean, buildings could be, it’s more accessible but that’s an ongoing need, but municipalities could make their trails [more accessible] and people in wheelchairs would gladly go around to things if they could … people in wheelchairs in particular, we have a tendency to think it’s all inaccessible, we can’t do any of it … well it could be accessible if there was a bunch of people who helped with it right?

3.1.3. Availability of Resources

Many participants stated that they experienced limitations in their social interactions and physical activity due to a lack of resources including equipment (e.g., prosthetics, wheelchairs, gait aids), resources of businesses to accommodate physical disabilities, accessible transit, and their own energy and motivation. Participants further commented on their experiences requesting improvements in accessibility of local business or service providers. Some establishments were willing and made changes within a few days, others stated they did not have the finances to make the changes needed, and yet others treated the individuals with disrespect and caused them to stop visiting the establishment. Jesse explains the importance and potential simplicity of making changes for people with disabilities:

At least making an effort to make—even places that aren’t … accessible, more accessible … getting … little ramps to help go over curbs. … Maybe when you’re building … a building, you know making your doors [wider]. I think doing that—or being open to, you know, having … both doors open. The little things like installing a button.

Jane sums up the overall lack of resources, commenting on her own experiences and that of others in her community:

Accessibility is a big factor … with the planning and physical structure … it can be the location, the lack of transportation, the access route to get to where you need to go, the lack of snow clearing, … the time of day, … even the cost, for many people that are living on low income, it’s not just disability—there’s many factors that kind of perpetuate the exclusion of others.

3.2. Advocates Are Needed to Share Knowledge

Participants described how advocates were important for creating and improving social networks, raising awareness, and educating others about physical disability, ensuring equal access for people with physical disabilities, and helping those with physical disabilities work through negative emotions. Advocacy was important for changing attitudes and subsequently increasing feelings of social inclusion and enthusiasm to participate. Jesse describes the role of advocates on their social experiences:

Being in groups, talking to people, being in a lot of groups and helping whenever you can … if you’re engaged, you’re going to events … maybe weekly clubs or weekly practices and weekly different groups that you go to help build your community … I learned a lot of my assets and my independence from different people throughout my [adapted sports] career … they could come out to practice and see how these people function … so that they can share the same independence a lot of these people do.

Other participants described how community advocacy organizations facilitate community ties and look out for the community and people with disabilities:

[community organization] they oversee a lot of community events and are invited to community events … So just having those community ties … it’s very nice to have part of the community and people actively looking out … for your interests and removing your barriers.

3.2.1. Representation in Organizations and Programs

Participants explained the need to increase representation of individuals with physical disabilities in organizations to contribute meaningful perspectives to community decisions. Including individuals with physical disabilities in a decision-making capacity may help overcome the lack of knowledge in community programming and communication, enhancing social inclusion and participation. Rebecca clarifies this idea with her own frustrating experiences:

I would use like the social system here if there was one, I wish there was such a way to find what is available athletically here for me … you need somebody that has [a physical disability] to come in and speak to you, it doesn’t, you know, having a social worker come in and go, I understand, well no, you don’t, you’ve got [no physical disability], we have to have somebody there that’s [got a physical disability] … there’s no group leading for people that have disabilities to come together and to do something as a group … we can build a community within the community and then make people stronger and feeling more confident about coming out and doing things and being more visible and not just hiding.

3.2.2. Education and Awareness

Education and awareness usually fall on the shoulders of those with physical disabilities. Many participants explained that, although education and awareness are vital to improving inclusion, it must be a community-wide activity to achieve inclusivity.

There’s a way to get people to become more educated so that they can reduces some of the education for the person who has the disability … and in general to recognize that we’re all part of the community, we need to make changes and adaptations to the environment and our belief system to help people become more inclusive, because we’re all a valuable part of it right?

—Ron

… but it’s making people aware and educating them the importance of physical activity for people with disabilities. It may look different how we engage in, in physical activity—but there are ways—it’s just looking outside of the box and the power to be looking outside the box on how they can be more able to make it more [accessible].

—Linda

3.2.3. Changing Attitudes

Negative attitudes towards people with physical disabilities were commonly noted by participants and impacted their feelings of inclusion in social and physical activities. Participants described experiencing negative attitudes from the general population and from themselves, including feelings of fear, embarrassment, and uncertainty. Rebecca explains the impact of poor attitudes on feeling included in her community:

I’ve had a lot of looks, I mean I’ve had [an elderly women] say to me ‘you should not be out here looking like that’ … people would want to hide … and just stating well I have a right be here in this community just as much as you do, and I think it’s what needs to start happening you know … because I think it’s a fear reaction because of how people have been treated through the years, because you’ve got that mentality that’s been brought forth from the past that people with [physical disabilities] are stupid or are not capable of doing things … and that’s discrimination … that’s not who I am, that’s not how, you know, I am not viewed as my disability.

What we need in the community—we just keep being visual … we need to show people that we want to be out in our … communities … because I think that’s what’s important to our quality of life as well. I heard comments that ‘oh well, you don’t see many of those people in wheelchairs, so why would we make changes?’ Well, it’s not just those people in the wheelchairs—it’s for everyone that we’re wanting to make these changes [for]. If the ramp is easier for a person with a cane, or a senior, or … for delivery people. Rather than having to bump up stairs. We’re not just being out there … for people who have disabilities throughout their community … it’s the education and the awareness that we have to do … it’s the biggest thing.

—Linda

3.3. Social Inclusion and Social/Physical Activity Influence Each Other

Participants expressed that social inclusion was a facilitator of physical and social activity and, reciprocally, how participation through social and physical activity can increase feelings of social inclusion. Participants framed this bi-directional relationship as important for overall health and wellbeing. Linda explains the importance of community engagement:

I think it’s just very important to be socially involved in any [sports and physical activities] and I think it’s good for anyone’s physical health to be involved in those things … and [their] emotional health.

3.3.1. Social Inclusion Facilitates Social/Physical Activities

Participants described a positive impact of the expansion of their social community on their physical activity levels. Improved social inclusion led to invitations and opportunities for participants to take part in social and physical activities, as Ron describes.

The social and community ties are important for anybody just to be able to get through life in general because it’s really hard if you’re socially isolated … because it’s affecting your mental health as well … and the more you’re involved in the community with social ties and what not then you start getting more involved in the physical activities that are in the community or available, because if you’re [socially isolated] you’re not gonna be aware of some of the things that are out there.

3.3.2. Social/Physical Activities Facilitate Social Inclusion

All participants explained that engagement in physical activity increased social connections and bonding that consequently increased their feelings of social inclusion. By participating in physical activities, participants benefit from interactions with others experiencing similar challenges, developing peer mentors and increasing knowledge of further social and physical activities that are accessible to the individual. Ron explains this connection:

I got involved in some things some sports related stuff like martial arts … and just getting out there and getting connected opened up a lot more physical activities and social opportunities that I didn’t have previously.

4. Discussion

The objective of this study was to explore the relationship between inclusion and participation in social and physical activities for individuals with physical disabilities. The themes generated focus on the physical and social accessibility of spaces and places, the important roles of advocates for changing attitudes and increasing awareness, the bi-directional relationship between inclusion and physical activity, and the facilitating role of inclusion for both social and physical activities. Considering the lived experiences of rural and remote community members together with the tenets of quality participation for persons with disability [13], our findings can be used to inform interventions to improve the physical accessibility of communities and social inclusion of individuals with physical disabilities across the intersecting levels of the social-ecological model. In particular, our findings advance work related to quality participation experiences for persons with physical disabilities by adding the voices of people living in rural, remote, or northern communities where the social and environmental context can alter barriers and opportunities.

Our findings highlight the need to address limitations in physical accessibility (e.g., the built environment) to improve community participation among people with disabilities and ensure full participation of persons with disabilities as a protected human right [12]. Changes suggested by participants aligned with community and organizational levels of the social-ecological model and included making new indoor and outdoor facilities accessible to wheelchairs and gait aids, improving existing physical spaces, and ensuring that individuals have access to necessary mobility aids. Our results reiterate and add new insights to previous literature, that having appropriate physical environment and the necessary equipment can facilitate engagement in social and physical activities [12]. Lack of physical access to spaces to be active is a consistently reported barrier to activity for people with disabilities [12,42] and may be particularly relevant for northern communities in Canada dealing with aging infrastructure and extended winter weather conditions [34]. Ensuring representation of individuals with physical disabilities in organizations, committees, and businesses can assist in creating spaces that are accessible (autonomy), foster a sense of belonging (belongingness) and accomplishment (challenge, mastery), and provide meaningful community roles (meaning) as described in models of quality participation [13]. However, this can risk tokenism as everyone can only speak from their own experience and may not have expertise in universal accessibility standards. In addition, placing the burden on people with disabilities to continually advocate for basic rights of accessibility can contribute to unnecessary burnout and fatigue. A sustainable solution would be the enactment and/or enforcement of policies related to accessibility and programming. While better accessibility standards for the built environment exist, they are not part of the enforceable minimum requirements in the building code in BC and are thus not likely to be applied to every setting.

More specific to the context of the northern BC built and natural environment, participants discussed how the outdoor infrastructure and climate-imposed barriers to social and physical activities. Participants discussed the inaccessibility of outdoor recreation opportunities, which aligns with previous work in this region [29,34] and reflects a unique culture, environment, and smaller population of advocates to ensure universal accessibility. The culture of northern BC is that of an industrial automotive-driven economy with a built environment that is not supportive of active travel has aging-inaccessible infrastructure [33]. Similar to what has been found in other rural areas [43,44], the lack of resources (e.g., human capital, access to specialized services) contributed to increased feelings of social isolation and reduced engagement in social and physical activities among participants. Given that interviews were conducted in January–March, which are winter weather months in northern BC, the issues related to weather and accessibility may have been particularly relevant for participants. These insights are relevant for municipal governments in northern BC and beyond to consider appropriate budgeting for snow clearing, bylaw enforcement, and urban design such as ensuring adequate curb cut-outs.

Having advocates to share knowledge and encouraging those without physical disabilities to educate themselves and learn about accessibility needs can also improve social participation, foster belongingness, and feelings of social inclusion for those with physical disabilities [18,29]. As feelings of embarrassment and judgement can be a barrier to social inclusion, support from family, friends, peers, and other community members can facilitate social inclusion and encourage participation in events and programs. Participants discussed not only concerns or attitudes of others impacting their engagement in social and physical activities, but also how these feelings were internalized and impacted feelings of acceptance and belongingness in social settings. Participants discussed the bi-directional relationship between social inclusion and engagement in physical and social activities. For example, feeling included led to being more likely to participate, and participating made participants feel more connected or included in their community. Thus, the importance of creating more feelings of social inclusion, through improving education and awareness of physical disabilities, as well as increasing physical and social accessibility, cannot be understated.

This study was conducted during the COVID-19 pandemic. People with disabilities have been disproportionately impacted and underserved by the pandemic, facing even greater social isolation, mental health challenges, and impacts on physical activity than the general population [45,46]. While participants expressed how the pandemic made them more aware of the importance of social and physical activities, it did require additional recall when explaining their experiences with social and physical activities as many indoor facilities were either closed during the period of data collection or participants did not feel safe accessing traditional spaces for physical or social activities. Secondly, due to the recruitment of participants through existing networks of a community organization, the people who chose to participate in the study were likely engaged in their communities via these networks. However, having people who were active gave the opportunity to fully discuss facilitators to community participation as participants were able to provide the most insightful knowledge and explore the nuances surrounding engagement in physical and social activities.

5. Conclusions

In this qualitative study, we have identified the value and importance of social inclusion as a facilitator of social and physical activity for people with physical disabilities. Our findings indicate a complex relationship between social inclusion and participation in social and physical activities, whereby improving both opportunities for physical and social activity can lead to increased feelings of community social inclusion, and increasing social inclusion can lead to social and physical activities for people with disabilities. Persons with physical disabilities living in rural, remote, or northern regions face additional barriers to accessibility, and due to a lower population, may need to rely more on advocates to ensure appropriate accessibility of spaces and places. Recommendations to foster social inclusion in similar rural, remote, or northern regions include accessible indoor and outdoor buildings, education, and awareness to challenge ableist attitudes. Considering a social–ecological framework, interventions can be designed at each of the individual, community, program, and environmental levels to ensure equal access to opportunities for full community participation. Future studies should explore co-development of interventions to address social inclusion, appropriate inclusion and representation of persons with disabilities in community design and decision making, and support of advocacy work.