Javier Monforte is a Postdoctoral Research Assistant at Durham University. His research focuses on disability and physical activity, and it combines thinking from sociology, psychology, philosophy, public health, and critical disability studies. He is part of a team that is developing a co-produced project called ‘Making Every Contact Count: Training the Social Workers of Today and Tomorrow in Supporting Disabled People to be Physically Active’. This 3-year project is funded by Sport England and the National Institute of Health Research (NIHR).
Disabled people can achieve huge benefits from physical activity (PA), but participation levels remain low. In response, policymakers and professionals are looking for ways for people experiencing different disabilities to get more active, more often, in ways that suit them.
But that’s no easy task. Effectively promoting PA to populations with impairments involves navigating a myriad of complex factors. Here, I focus on an essential factor: meaning.
The point I want to share with professionals and policymakers is the following: considering what PA means to Disabled individuals and groups is vital.
This might seem like an obvious point, but the truth is that a multitude of PA promotion interventions, training programmes and support resources miss it. To put it another way, PA advice is often offered without careful consideration of what PA means to the person being advised. This is a problematic oversight insofar as meaning precedes motivation, and only after we have found congruence between the task at hand and our original intentions and values can we find full motivation to engage in the activity.
Thankfully, this oversight is being corrected. For one thing, the value of personalisation or the person-centred approach to care is increasingly recognised. This approach is about seeing a person as an expert in oneself and delivering care based on each person’s individual context, experiences, values… and meanings!
For another thing, emerging research findings from a nationwide study (available on request till published) situate meaning as a core content of PA promotion in future social work education. In this study, all the members of a selected group of experts in disability, PA and social work agreed that it will be much more important for social workers to learn about personal meanings than to study the CMO guidelines or the FITT Principle.
That’s not to say that studying such content is useless. Rather, we should read the results as the expression of an appetite for change: from promoting PA to Disabled people to promoting PA with them.
What does this look like in action?
Imagine I’m a social worker encouraging a man with a spinal cord injury (SCI) to do PA. To offer him personalised support, I need to do a number of things including the following two. Firstly, I need to get a general sense of the most common meanings of PA amongst men with SCI. To illustrate, studies have shown that men can interpret PA as the vehicle through which return to his their former able body, uphold a certain form of masculinity, incorporate the wheelchair to their sense of self, or feel empowered as part of a wide collective of peers.
Secondly, I need to know what PA participation means to him. PA can have multiple, unstable and even conflicting meanings. At least, we need to know the dominant ones. It’s also very important to identify past negative experiences, and how they shaped his current meanings. If we ignore them, not only we’ll fail to provide suitable guidance; ironically, we’ll also risk turning him away from PA instead of helping him live an active life as intended. When you look at it this way, getting to know what PA means to Disabled people becomes an ethical obligation.
Practicality and physical activity
Now, a practical question arises: How can I get to know what PA means to someone? Academics suggest that the answer should not be as simple as: ask the person why they do or do not participate in PA. It “requires more than simply asking people why they engage in sport and replacing the word motivation with meaning”.The above might mean that, in order to capture experiential meanings -rather than surface descriptions- we need to give more weight to the evoking stage of motivational interviewing. For this purpose, it is useful to evoke stories, rather than mere motivational statements. People attach meaning to their experiences and decisions through the stories they tell. Meaning is hidden below the surface, and it comes out through storytelling.
Listening to stories is part of care work, but it’s more than a routine task or a clinical technique. It’s a form of care -called narrative care. Care workers need to practice it.
I am aware of their time constraints. Many can’t dedicate indefinite time to the empathic (not just instrumental) witnessing of the person’s stories of disability. I believe that such impossibility is a limitation we’ll need to overcome, a glass ceiling we’ll need to break. If well-trained care workers can’t allocate time to attend to the stories in which Disabled people reveal the meanings they attach to PA, they won’t be able to take PA promotion to the next level.
Alas, they will not be given that time. They will have to reclaim it.