Participation intention and adherence in organised sport among people with physical disability in Switzerland: A multilevel and random forest analysis

Vollständiger Abstract

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Introduction & purpose: Physical activity (PA) is vital for the health of individuals with physical disabilities (IWPDs), reducing their risk of multimorbidity (Brinkhof et al., 2016). As IWPDs are significantly less active than the general population (WHO, 2022), organised sport – like regular wheelchair sports groups offered by wheelchair clubs of the Swiss Paraplegic Association (SPA) – can serve as a PA promoting setting. While research, including multilevel approaches, has studied intention and adherence in leisure-time PA settings, only scarce research exists for settings like regular wheelchair sports groups (Martin Ginis et al., 2016; Schlesinger & Nagel, 2015; Sivaramakrishnan et al., 2023). Applying a socio-ecological approach, this study investigated the relevance of individual and club-level factors on adherence in wheelchair sport groups among all members (active vs. inactive) (RQ 1) and the influence of individual factors on intention to participate in a wheelchair sport group (non-participants, RQ2) among SPA members. Methods: This study employs an explorative cross-sectional quantitative research design. Data was collected from February until June 2025 including an online survey of SPA members (n=273), targeting a highly specific sample of IWPDs in Switzerland, and structured interviews with board members (n=26). Adherence to sport (yes/no) and intention to participate (0-100) were primary outcomes. For RQ1, a logistic multilevel regression model was employed. Due to a low ICC (.06) in the null model, a small, predetermined number of clusters (n=26 SPA wheelchair clubs) and highly unbalanced clusters, only L1 predictors were included in the analysis, retaining the random intercept to adhere to the multilevel data structure. For RQ2, random forests will be used, as successfully applied in other IWPDs research (e.g. Gross-Hemmi et al., 2021). Results: For RQ1, small cluster variance (tau^2_00 =.22) was found, indicating little difference between wheelchair clubs’ affiliation regarding the outcome variable. Using a backwards-selection approach, the best-fitting model identified standardized ORs (change per one SD) for motivation for sport (OR=3.71, 95%CI: [2.12, 6.42], p < .001), wellbeing (OR=2.32, 95%CI: [1.42, 3.74], p < .001), and age (OR=.57, 95%CI: [.40, .82], p < .01), negatively associated with the odds of adherence, as the strongest individual-level predictors. Furthermore, overall satisfaction with club characteristics (OR=1.70, 95%CI : [1.12, 2.56], p < .05), satisfaction with social life (OR= .65, 95%CI: [.43, .99], p < .05), and being female (OR=.53, 95%CI: [.26, 1.08], p ≤ .10) were also important predictors, with the latter two negatively associated with the odds of adherence. Predictors for intention (RQ2) from the random forest analysis will be detailed in the presentation. Discussion/conclusion: The findings underscore the high importance of psychological factors (e.g. motivation, wellbeing) as strong predictors of sports groups adherence, confirming existing literature and providing novel insights, notably the predictive role of satisfaction with club characteristics (Martin Ginis et al., 2016; Schlesinger & Nagel, 2015). The results suggest tailored interventions focusing on both individual factors and club support. While the self-report, cross-sectional design limits causal claims, these findings are valuable for guiding future research and informing strategy development by national federations (e.g. SPA). References Brinkhof, M., Al-Khodairy, A., Eriks-Hoogland, I., Fekete, C., Hinrichs, T., Hund-Georgiadis, M., Meier, S., Scheel-Sailer, A., Schubert, M., & Reinhardt, J. (2016). Health conditions in people with spinal cord injury: Contemporary evidence from a population-based community survey in Switzerland. Journal of Rehabilitation Medicine, 48(2), 197–209. https://doi.org/10.2340/16501977-2039 Gross-Hemmi, M. H., Fekete, C., Post, M. W. M., Scheel-Sailer, A., Schwegler, U., & Brinkhof, M. W. G. (2021). Detecting subgroups in social participation among individuals living with spinal cord injury: A longitudinal analysis of community survey data. Spinal Cord, 59(4), 419–428. https://doi.org/10.1038/s41393-020-00576-3 Martin Ginis, K. A., Ma, J. K., Latimer-Cheung, A. E., & Rimmer, J. H. (2016). 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