A scoping Review of Tools to Evaluate Existing Playgrounds for Inclusivity of Children with Disabilities

Introduction: Children with disabilities may be unable engage playground spaces due to barriers exacerbating exclusion. Therefore, clarity on how to evaluate existing playgrounds for inclusivity of children with disabilities is required.

Methods: A scoping review was undertaken to explore auditing tools.

Results: Fourteen white and grey literature resources were identified. The term “inclusion” was operationalized differently across tools, primarily focusing on physical accessibility. Characteristics of the tools were synthesized into 13 inclusive design recommendations for playgrounds. Two tools showed promise, evaluating 12/13 recommendations.

Discussion: The results of this review provide guidance on existing tools for evaluating playgrounds for inclusion for community stakeholders and researchers.

Systematic Review Registration: https://osf.io/rycmj.

1. Introduction

Play is a fundamental right of childhood (1), and has important implications for a child's wellbeing and healthy development (2). Children's environments shape opportunities for engaging in play, which further influences their physical health, social skills, and emotional wellbeing (3, 4). For example, access to community playgrounds (i.e., any fixed equipment used for play, typically found in parks, schoolyards, and childcare and recreation facilities: Canadian Standards Association) (5), is positively associated with children's levels of unstructured play (3), which supports increased physical activity levels and cardiorespiratory fitness, and decreased sedentary behavior (6–8). However, research suggests that children with disabilities experience exclusion in accessing and engaging in community playgrounds, and therefore, are less likely to reap the associated benefits (9, 10).

Children with disabilities can experience environmental barriers on playgrounds caused by inappropriate equipment (i.e., ground cover, inappropriate pathways, complex design, lack of alternative equipment, etc.), inadequate play options and play value, and limited opportunities for social interaction (11). These barriers impede full participation in play. This finding is concerning as globally, approximately 240 million children have a disability that limits their full participation in society (12). Creating engaging and inclusive environments, which support and facilitate children's participation, is crucial to extending the benefits of play to all children.

Inclusion emphasizes the full participation of individuals of all abilities by providing a space to interact, engage, and belong (13). Consequently, inclusive playground environments can facilitate entry to play and allow children with disabilities to feel like equal participants who can access and engage in the physical and social aspects of play (14). Inclusion encompasses design features such as accessibility (the physical ability of people to access the play space), useability (subjective perception of an individual's ability to engage in an activity within their environment), and playability (providing opportunities for individuals of all abilities to engage in play). Inclusion can be achieved through universal design; ensuring the built environment meets the needs of as many people, to the greatest extent possible (11).

It is important to consider how playground design can impact social inclusion and a child's right to play. In regards to inclusion and play-related policy, 196 countries have ratified the United Nations Convention on the Rights of the Child, which indicates that every child has the right to active participation in age-appropriate play, recreation, and their community (1). Furthermore, the United Nations Convention on the Rights of Persons with Disabilities has been ratified by 185 countries, and emphasizes that for individuals with disabilities to experience full inclusion in their communities, accessible, barrier-free physical and social environments are required (15).

On an international scale, some guidance is available via country-specific legislation governing new playground design (e.g., Australia/New Zealand: AS/NZS 4685, Australia: AS 4422; Britain and Europe: BS/EN1176; Canada: Z614:20; Brazil: NBR 16,071) (16). In 2010, the United States released the Americans with Disabilities Act Standards for Accessible Design (ADA Standards) (17). This resource provides minimum acceptable standards for designing accessible playgrounds relevant to American legislation, and are commonly referred to in global applications (16). In Canada, three out of 13 provinces/territories have enacted comprehensive accessibility laws (Ontario, Nova Scotia, and Manitoba); however, outside of Ontario, legislation governing accessibility on playgrounds is scarce (18).

While country-respective accessibility standards are a positive starting point for play opportunities for all children, they typically focus on recommendations for designing new, accessible playgrounds; this results in little guidance available for retrofitting established play structures. Furthermore, government policy alone is often insufficient to draw awareness to the specific barriers experienced by children using playgrounds in their communities (19). Research has indicated that playground accessibility and usability may not be successfully implemented despite accessibility standards being put in place (20). Clear guidance on tools available to evaluate existing structures is necessary to inform decision-making and address priorities (e.g., municipal funding, urban design, community health). This will aid in informing resource allocation for improving inclusivity for children with disabilities, to participate in play in their everyday environments.

Improved clarity on how to evaluate and retrofit or redesign existing playground structures for inclusivity is required. However, previous systematic and scoping reviews have not addressed how to evaluate existing playgrounds for inclusion, but instead focus on best practices for designing new structures (21–24). While applying design best practices for new playgrounds is a positive starting point to examine inclusion on existing playgrounds, auditing tools should quantify the strengths and limitations of a playground space as it currently stands for practical and financial reasons. Playground audits have been used in research and practice to measure and evaluate attributes of the play space environments (25, 26), and can be employed to evaluate playground inclusion (27). Using auditing tools in existing spaces allows community stakeholders and researchers to evaluate the state of current community playground structures. This process can support the identification of current equipment that meets user needs, and to address limitations and recommend adaptations or modifications to problem areas which better suit the needs of all children (i.e., retrofits, renovations, or re-designs). However, it is unclear if a best-practice tool exists for evaluating the inclusivity of existing playgrounds.

The purpose of this scoping review was to explore available tools for auditing the inclusivity (to enable the participation of children with disabilities) of existing playgrounds in both research and practice settings. The overarching objective was to provide researchers and community stakeholders (e.g., government officials, child development and recreation practitioners, playground developers, and community disability champions) with resources for evidence-based decision-making to improve the inclusivity of playgrounds. The audit process has the potential to engage these diverse groups in meaningful, community-based research through evaluations and advocacy for improved playground environments (26). Unlike previous research which has primarily focused on informing inclusive design for new builds (21–24), this study narrowed the breadth of evidence to examine literature that provides auditing tools to evaluate the design of existing playgrounds, an important and unexplored contribution for community applications.

2. Methods

This scoping review was prospectively registered with Open Science Framework (registration #: rycmj) and conforms to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) extension for Scoping Reviews (28). The protocol for this review was published a priori and full study details can be found there (29). The scoping review methodology was selected for this research because it allowed for an appropriate summary of the heterogenous evidence available, with the goal of identifying gaps and informing policy and practice (30, 31).

2.1. Search strategy

The search strategy was created and conducted in consultation with a Health Sciences Teaching and Learning Librarian at Western University (Ontario, Canada). In line with the scoping review methodology (31), white and grey literature were included to capture the breadth of auditing tools available in the fields of research and practice. The search was undertaken in a two-phase process.

2.1.1. Phase 1: white literature

The primary search examined empirical, peer-reviewed research (i.e., white literature) which focused on three key themes: 1) the playground environment; 2) children with disabilities (i.e., physical, intellectual, mental, or sensory impairments which interact with barriers to hinder full and equal participation in daily life) (15); and (3), audit tools for evaluating the inclusivity of the playground (refer to the protocol paper for the complete search strategy) (29). Themes 1 and 2 were systematically examined using relevant keywords and medical subject heading (MeSH) terms, combined using Boolean operators and adjusted for four electronic databases: MEDLINE, Scopus, CINAHL, and Embase. Theme 3 was evaluated by hand during screening to account for the variety of terminology used to refer to audit tools. Audit tools were considered broadly as any tool that can be employed to conduct an evaluation of the playground for the inclusion of children with disabilities, using questions that can be completed by a playground auditor (29). Hand searches of the reference lists of included articles and four previous systematic/scoping reviews examining inclusive playground design were undertaken to locate additional eligible white and grey literature (21–24). The final search was conducted on December 18, 2021. All retrieved white literature was exported into the Covidence software for screening and data extraction (32).

To be included, original peer-reviewed research (i.e., white literature) had to be published in English or French since 2000. Studies had to evaluate the inclusivity of existing playground structures (equal access to social and physical aspects of play, regardless of ability) (21, 22), and provide an objective tool (i.e., toolkit, evaluation, audit, checklist, assessment, etc.) to conduct an evaluation of a playground for inclusion of children with disabilities, using questions that can be completed by a playground auditor. Studies were excluded if the full-text article could not be obtained, “playground” was defined in an alternate context (e.g., an environmental playground of bacteria), or the focus of the paper was strictly on the epidemiology of injury or playground safety (21).

2.1.2. Phase 2: grey literature

Using the direction of Godin et al (33)., a grey literature search was conducted by applying a 3-step process for recording the relevant literature. Step 1 involved a search of a grey literature database, the Canadian Health Research Collection Database. Step 2 focused on conducting targeted web-based google searches. Snowball searching was used in Step 3 by examining the reference lists on all white and grey literature included in the full-text screening stages for additional grey literature. The final grey literature search was conducted on March 2, 2022. All retrieved grey literature was exported into Microsoft Excel and assigned a unique identifier for screening and data extraction.

Grey literature (i.e., reports, theses, newspapers, fact sheets, websites, and policy documents produced by government/academics/industry not controlled by commercial publishers) were required to meet al.l inclusion criteria of white literature, with slight modifications (33). Acknowledging the potential volume of grey literature available, an additional inclusion criterion was employed: to ensure that the results of this scoping review reflect best practices for end-users, the grey literature had to report how the tool was developed. Two additional exclusion criteria for grey literature were also applied: 1) secondary applications of tools with unjustified modifications to an original tool reported by another organization; and, 2) examples of organizations applying existing tools in practice. In these situations, the primary source of the tools used was assessed for inclusion in this review.

The results and inclusion process adhered to, and are presented on, the “PRISMA 2020 flow diagram for new systematic reviews, which included searches of databases, registers and other sources” (see Figure 1) (34).

FIGURE 1

Figure 1. PRISMA flow diagram. *Number indicates search where first 10 pages (i.e., 100 results) were reviewed if results were considered infinite, to capture many of the most relevant hits while still being a feasible amount to screen (Godin et al., 2015). ^†Searches using first 10 pages of search results only.

2.2. Screening process & data extraction

Title, abstract, full-text screening, and data extraction of all literature were conducted by two researchers. White literature was managed in Covidence (32), while grey literature was documented in Microsoft Excel. Discrepancies were discussed with a third reviewer until consensus was achieved.

Separate data extraction tables for white (Table 1) and grey (Table 2) literature were generated a priori. The tables captured the relevant auditing tool characteristics and detailed all applicable resource information, and results of studies for white literature.

TABLE 1

Table 1. Characteristics of white literature audit tools.

TABLE 2

Table 2. Characteristics of Grey Literature Audit Tools.

2.3. Analysis

To compare and synthesize heterogeneous auditing tools, 13 recommendations and one “promising practice” (i.e., area for future research) to design for inclusion by Brown et al. were employed (Table 3) (21). These evidence-based recommendations, developed following a scoping review, provide guidance for designing new playgrounds with consideration to both the physical design and the surrounding built and social environments. The questions from each auditing tool were extracted and synthesized into the recommendations for designing inclusive playgrounds. Frequencies of recommendations employed were calculated and tool applications were explored. Strengths and weaknesses of employing the auditing tools in research or practice were examined (see Tables 1, 2 respectively).

TABLE 3

Table 3. Synthesis of auditing tool assessments into recommendations and ‘promising practice’ for playground design.

3. Results

The white literature database search yielded 2,030 results with 559 duplicate records. Titles and abstract screening determined 1,289 to be irrelevant; therefore, 167 full-text articles were screened. Eight peer-reviewed studies met the inclusion criteria. The grey literature searches located 3,456 articles. When a google search pulled more than 100 articles (n = 4 searches), the first 10 pages of the search results were examined (32). Of these results, 3,008 articles were determined ineligible for inclusion and 448 titles/abstracts were screened. Full-text screening resulted in 10 grey literature articles. Four full-texts were associated with the same article and were extracted as one (17), leaving six grey literature articles. Figure 1 displays a flow diagram of the studies retrieved for the review.

A total of 14 auditing tools were included; published between 2001 and 2022 (half published since 2017), from the United States (n = 4), Australia and New Zealand (n = 3), the United Kingdom (n = 2), Canada, Turkey (n = 1), Brazil (n = 1) and Ireland (n = 1). Specific characteristics of each article including measures of inclusion, disability types considered, tool methodology, and key findings are presented in Table 1 (white literature) and Table 2 (grey literature).

Across tools, inclusion was operationalized using a variety of terminology (i.e., playability, useability, universal design: see Tables 1, 2); however, accessibility specific to the physical space was a consideration in all tools. While these tools were grounded in policy/legislation, stakeholder consultation, and research, none assessed psychometric properties. Disability was often considered strictly in a physical capacity (n = 5). Three tools referenced multiple types of disabilities, while six did not specify the disability type being considered (see Tables 1, 2). All tools operationalized disability in relation to the playground environment, focusing on removing barriers to allow for children of all abilities to engage in play.

3.1. Descriptive findings

Of the eight peer-reviewed articles (9, 20, 35–40), each used a different tool for evaluating playground accessibility, with five referencing the ADA Standards as their guiding framework (17). All authors emphasized the need for auditing tool development and validation, and for future research to incorporate families who experience disability when establishing research priorities, developing and validating auditing tools, conducting playground assessments, and translating results. See Table 1 for characteristics of white literature.

Among the six tools identified in the grey literature (17, 41–45) all were applications of various policy, legislation or regulation, intended to support practitioners and community stakeholders to upgrade existing playgrounds to be more inclusive for all users. All grey literature expanded beyond the playground/play space to consider the entire park (e.g., bathrooms, parking and access paths). See Table 2 for characteristics of grey literature.

3.2. Auditing tools characteristics

When the auditing tools (n = 14) were compared to Brown and colleagues' 13 recommendations and one “promising practice” (Table 3) (21), most tools (n = 8; 57.1%) provided questions to evaluate more than half of these recommendations. The tools which evaluated less than half of the recommendations were primarily found in the white literature (n = 4; 28.6%). Two grey literature tools (both from Australia) provided sufficient information to evaluate against 12 of 13 recommendations (42, 45), and one targeted 10 out of the 13 recommendations (44). All tools evaluated more than 50% of the recommendations in the combined entry points and surfacing/paths categories (accessibility-related categories); however, only six evaluated more than half of the recommendations in the features to foster inclusive play category (9, 38, 42–45), or included user involvement (i.e., families of children with disabilities and representatives from disability organizations) in the design process (9, 35, 42–45). No tools in the literature provided a question to assess supervision/staffing on the playground. See Table 3 for a summary of the questions provided in auditing tools, categorized by the recommendations (and “promising practice”) for playground design from Brown et al. (19).

4. Discussion

The purpose of this scoping review was to explore tools available to evaluate the inclusivity of existing playgrounds to enable the participation of children with disabilities. Several evidence-based tools exist to evaluate aspects of inclusion on playgrounds. While accessibility was the main consideration of auditing tools, three grey literature tools aligned well with the recommendations set forth by Brown et al. for designing inclusive playgrounds (19, 42, 44, 45). These tools demonstrate promise for use by researchers, practitioners and community stakeholders (e.g., public health/recreation/government officials, playground developers, and community champions) who are looking to audit the current state of inclusion in their local playgrounds. Several findings warrant discussion.

There were few peer-reviewed articles which employed auditing methodology to evaluate existing playground structures for inclusion, none of which were validated. While no two studies in this review used the same auditing methodology, five referred to the ADA Standards. While this resource provides a focused method for evaluating physical accessibility to playgrounds, it comes at the expense of the wider experience of inclusion (e.g., social accessibility), which is not being captured in playground audits. This presents the potential for a lack of critical engagement in exceeding minimum accessibility standards for play opportunities which include children of all abilities (19).

Evaluating for inclusion, rather than accessibility alone, is key to capturing the experience of children with a wide range of disabilities and providing equitable play opportunities for all. Government legislation and standards can function as a starting point to evaluate accessibility under the umbrella of inclusion (21); however, features to foster inclusive play from usability, playability, and universal design approaches should also be considered. This process should include an examination of the evidence-informed literature captured in this review.

Of the tools examined in this review, one third suggested including families of children with disabilities and representatives from disability organizations in the audit process (9, 35, 42–45). This finding echoes a Dutch study where one quarter of municipalities surveyed had never consulted playground users such as parents and children when designing new community playgrounds (19). A lack of involvement of users in the evaluation and design of playgrounds may mean that barriers to interaction, engagement, and belonging in play may not be adequately caputured (13, 14). If children are not involved in audits, it raises an important question: who is evaluating children's experiences and from what perspective? As emphasized in the literature, it is critical that families with children who have disabilities be engaged in this process as key stakeholders in research and practice to ensure that inclusion is considered and integrated practically. For example, a recent scoping review by Morgenthaler and colleagues suggested that children were knowledgeable about the play value of their community playgrounds, and therefore, their perspectives need to be more closely considered in evaluation of these spaces (46). Not only is it critical to engage playground users in audits to gain insight about playground experiences of inclusion, but also to maximize use of these community spaces by ensuring children's preferences and needs are being met when adaptations are being considered (47).

When undertaking a playground audit to evaluate inclusion, the application of an evidence-based tool can inform decision-making and address relevant priorities. This review identified that although each tool has strengths and limitations, and promising tools exist that will be useful for guiding users in the auditing process, there is currently no best-practice, or widely accepted tool available based on current recommendations for designing inclusive playgrounds (21). The auditing tools identified should be critically appraised prior to use, and considerations such as local users, relevant policy/legislation, and environmental contexts should be considered before use. Applications of these auditing tools would benefit from tailoring tools to local needs based on the gaps identified in this review.

Future development of an auditing tool that allows for consistent, valid assessments of playground inclusion will be important for determining funding allocation, feasibility for upgrading vs. replacing structures, and grassroots advocacy opportunities, to maximize inclusiveness and the overall playground experiences for children with disabilities. Such a tool would have important implications for community-based research, knowledge mobilization, and informing resource allocation (26). Similarities between country-specific playground standards could be drawn on to develop a validated tool that aligns well with all national and international standards. This tool could bridge research and practice to evaluate community settings to better suit the needs of all children.

The present review highlighted gaps in the playground inclusion literature, which should be addressed when considering the future development of an auditing tool. Specifically, it is important that children's health and recreation practitioners, researchers, and government officials establish acceptable standards of inclusion for existing playground structures, which extend beyond accessibility alone. To do this, it is critical to engage with playground users, as they are the ones who play a key role in establishing what a standard of inclusion looks and feels like. Future research should employ qualitative techniques in playground audits to capture these voices. Furthermore, future research should determine best-practice directions which can be used to retrofit existing playgrounds deemed non-inclusive based on the results of audits and investigate how these retrofits affect all children's abilities to engage meaningfully in play. These lines of investigation will help researchers, practitioners, and community stakeholders to better advocate for the inclusion of all children in play opportunities within their communities.

This research makes an important contribution to the literature by systematically summarizing both white and grey literature globally, to provide auditing tools for evaluating the design of existing playgrounds. There are, however, limitations to this review that warrant acknowledgement. First, this study was limited to published white and grey literature available in English and French, introducing the potential for language bias. In two cases, studies published in English provided auditing tools unavailable in English, and therefore, were examined based on the information provided within the article (20, 39). This may have introduced potential bias in the interpretation of the findings. Secondly, for inclusion in this review, the literature had to present an auditing tool to evaluate the inclusivity of existing playground structures. As a result, studies which employed qualitative or survey-based methodology to measure users' perspectives and experiences of inclusion may have been excluded. Finally, while this review sought to systematically examine the grey literature, there are inherent biases involved in this process despite best efforts to ensure scientific rigour (33). Inclusion of the grey literature provided important practical implications for auditing existing playgrounds, and therefore, was undertaken with current best-practice research strategies available for ensuring limited biases of results (33).

Although redesigning and reinstalling new playgrounds that are inclusive for all users, would be ideal, it is not realistic. Based on the results of this review, future applications of the promising tools identified should take into account the local contexts (i.e., users, policy and environment) when conducting audits. Moreover, it is recommended that an auditing tool focusing on inclusion that can be consistently implemented in research and practice settings to evaluate the inclusion of existing playgrounds be developed and validated. This will allow researchers, practitioners and community stakeholders to examine opportunities for improving inclusivity and supporting the health and wellbeing of children with disabilities in their everyday environment through play, a fundamental right of every child.

Data availability statement

The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author.

Author contributions

LGT was the primary author responsible for generating the protocol, undertaking the search and data analysis, and writing the manuscript. MP was responsible for data analysis and writing the manuscript. LMV was responsible for developing the protocol, analyzing the data, and writing/editing the manuscript. KPAN, JL and JG were responsible for supporting development of all study materials, interpreting the findings and editing the manuscript. PT was the senior author. All authors contributed intellectually to all aspects of the process. All authors contributed to the article and approved the submitted version.

Funding

This research was supported by Western Research, through the Research Mobilization, Creation, & Innovation Grant.

Acknowledgments

The authors thank Meagan Stanley (Teaching and Learning Librarian, Western University) for her guidance developing and support implement this review's search strategy.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

References

1. United Nations. Convention on the rights of the child. United nations, Treaty Series. (1989);1577(3):1–23.

Google Scholar

2. Nijhof SL, Vinkers CH, van Geelen SM, Duijff SN, Achterberg EM, Van Der Net J, et al. Healthy play, better coping: the importance of play for the development of children in health and disease. Neurosci Biobehav Rev. (2018) 95:421–9. doi: 10.1016/J.NEUBIOREV.2018.09.024

PubMed Abstract | CrossRef Full Text | Google Scholar

3. Lee EY, Bains A, Hunter S, Ament A, Brazo-Sayavera J, Carson V, et al. Systematic review of the correlates of outdoor play and time among children aged 3–12 years. Int J Behavioral Nut and Physical Activity. (2021) 18(1):1–46. doi: 10.1186/S12966-021-01097-9

CrossRef Full Text | Google Scholar

4. Reimers AK, Schoeppe S, Demetriou Y, Knapp G. Physical activity and outdoor play of children in public playgrounds—do gender and social environment matter? Int J Environ Res Public Health. (2018) 15(7):1356. doi: 10.3390/IJERPH1507135

PubMed Abstract | CrossRef Full Text | Google Scholar

5. Canadian Standards Association. Children's playground equipment and surfacing. CSA Z614:20 national standard of Canada. Toronto: CSA Group; (2020).

6. Brussoni M, Gibbons R, Gray C, Ishikawa T, Sandseter EB, Bienenstock A, et al. What is the relationship between risky outdoor play and health in children? A systematic review. Int J Environ Res Public Health. (2015) 12(6):6423–54. doi: 10.3390/IJERPH120606423

PubMed Abstract | CrossRef Full Text | Google Scholar

7. Gray C, Gibbons R, Larouche R, Sandseter EB, Bienenstock A, Brussoni M, et al. What is the relationship between outdoor time and physical activity, sedentary behaviour, and physical fitness in children? A systematic review. Int J Environ Res Public Health. (2015) 12(6):6455–74. doi: 10.3390/IJERPH120606455

PubMed Abstract | CrossRef Full Text | Google Scholar

8. Stone MR, Faulkner GE. Outdoor play in children: associations with objectively-measured physical activity, sedentary behavior and weight status. Prev Med. (2014) 65:122–7. doi: 10.1016/J.YPMED.2014.05.008

PubMed Abstract | CrossRef Full Text | Google Scholar

9. Lynch H, Moore A, Edwards C, Horgan L. Advancing play participation for all: the challenge of addressing play diversity and inclusion in community parks and playgrounds. Br J Occup Ther. (2020) 83(2):107–17. doi: 10.1177/0308022619881936 Resource detailed at: https://lawson.ca/wp-content/uploads/2018/12/6.-Universal-Design-and-sociospatial-inclusion-in-outdoor-playspaces-Ireland-HLynch.pdf

CrossRef Full Text | Google Scholar

10. Prellwitz M, Skär L. Usability of playgrounds for children with different abilities. Occup Ther Int. (2007) 14(3):144–55. doi: 10.1002/OTI.230

PubMed Abstract | CrossRef Full Text | Google Scholar

11. Moore A, Lynch H, Boyle B. Can universal design support outdoor play, social participation, and inclusion in public playgrounds? A scoping review. Disabil Rehabil. (2022) 44(13):3304–25. doi: 10.1080/09638288.2020.1858353

PubMed Abstract | CrossRef Full Text | Google Scholar

12. UNICEF Division of Data, Analytics, Planning and Monitoring. Seen, Counted, Included: Using Data to Shed Light on the Well-Being of Children With Disabilities. New York: United Nations Children's Fund; (2021).

13. Moore A, Boyle B, Lynch H. Designing for inclusion in public playgrounds: a scoping review of definitions, and utilization of universal design. Dis and Rehab: Assistive Technol. (2022):1–3. doi: 10.1080/17483107.2021.2022788

CrossRef Full Text | Google Scholar

14. Spencer-Cavaliere N, Watkinson EJ. Inclusion understood from the perspectives of children with disability. Adapt Phys Activ Q. (2010) 27(4):275–93. doi: 10.1123/APAQ.27.4.275

PubMed Abstract | CrossRef Full Text | Google Scholar

15. United Nations. Convention on the rights of persons with disabilities. New York: United Nations General Assembly (2006).

16. Grover P. Standards and regulations (general and best practice principles). In: Masiulanis K, Cummins E, editors. How to grow a playspace. Routledge (2017) p. 337–40. doi: 10.4324/9781315695198-CH43

17. American Disability Association. Chapter 10: Play Areas. In ADA Standards for Accessible Design. Disabil Health J. (2010).

18. Canadian Public Health Association. Accessibility and Usability of Play Spaces. (2019). https://www.cpha.ca/sites/default/files/uploads/resources/play/play_accessibility_summary_e.pdf

19. Van Melik R, Althuizen N. Inclusive play policies: disabled children and their access to Dutch playgrounds. Tijdschrift Voor Economische en sociale Geografie. (2022) 113(2):117–30. doi: 10.1111/tesg.12457

CrossRef Full Text | Google Scholar

20. Talay L, Akpinar N, Belkayali N. Barriers to playground use for children with disabilities: a case from Ankara, Turkey. Af J Agr Res. (2010) 5(9):848–55. doi: 10.5897/AJAR.9000082

CrossRef Full Text | Google Scholar

21. Brown DM, Ross T, Leo J, Buliung RN, Shirazipour CH, Latimer-Cheung AE, et al. A scoping review of evidence-informed recommendations for designing inclusive playgrounds. Front Rehab Sci. (2021) 2:664595. doi: 10.3389/FRESC.2021.664595

CrossRef Full Text | Google Scholar

22. Fernelius CL, Christensen KM. Systematic review of evidence-based practices for inclusive playground design. Child Youth Environ. (2017) 27(3):78–102. doi: 10.7721/CHILYOUTENVI.27.3.0078

CrossRef Full Text | Google Scholar

23. Mejeur M, Schmitt G, Wolcott H. A systematic review of the best practices for playground inclusion. https://scholarworks.gvsu.edu/ot_pediatrics/1

24. Moore A, Lynch H. Accessibility and usability of playground environments for children under 12: a scoping review. Scand J Occup Ther. (2015) 22(5):331–44. doi: 10.3109/11038128.2015.1049549

PubMed Abstract | CrossRef Full Text | Google Scholar

25. Brownson RC, Hoehner CM, Day K, Forsyth A, Sallis JF. Measuring the built environment for physical activity: state of the science. Am J Prev Med. (2009) 36(4):S99–123. doi: 10.1016/J.AMEPRE.2009.01.005

PubMed Abstract | CrossRef Full Text | Google Scholar

26. Kaczynski AT, Stanis SA, Besenyi GM. Development and testing of a community stakeholder park audit tool. Am J Prev Med. (2012) 42(3):242–9. doi: 10.1016/J.AMEPRE.2011.10.018

PubMed Abstract | CrossRef Full Text | Google Scholar

27. Woolley With H, Armitage M, Bishop J, Curtis M, Ginsborg J. Going outside together: good practice with respect to the inclusion of disabled children in primary school playgrounds. Chil Geographies. (2006) 4(3):303–18. doi: 10.1080/14733280601005666

CrossRef Full Text | Google Scholar

28. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. (2018) 169(7):467–73. doi: 10.7326/M18-0850/SUPPL_FILE/M18-0850_SUPPLEMENT.PDF

PubMed Abstract | CrossRef Full Text | Google Scholar

29. Taylor LG, Vanderloo LM, Arbour-Nicitopoulos KP, Leo J, Gilliland J, Tucker P. Playground inclusivity for children with a disability: protocol for a scoping review. JMIR Res Protoc. (2022) 11(7):e37312. doi: 10.2196/37312

PubMed Abstract | CrossRef Full Text | Google Scholar

30. Munn Z, Peters MD, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. (2018) 18(1):1–7. doi: 10.1186/S12874-018-0611-X/TABLES/1

PubMed Abstract | CrossRef Full Text | Google Scholar

31. Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. JBI Evidence Implementation. (2015) 13(3):141–6. doi: 10.1097/XEB.0000000000000050

CrossRef Full Text | Google Scholar

32. Covidence Systematic Review Software. Veritas health innovation.

33. Godin K, Stapleton J, Kirkpatrick SI, Hanning RM, Leatherdale ST. Applying systematic review search methods to the grey literature: a case study examining guidelines for school-based breakfast programs in Canada. Syst Rev. (2015) 4(1):1–0. doi: 10.1186/S13643-015-0125-0/FIGURES/2

PubMed Abstract | CrossRef Full Text | Google Scholar

34. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. (2021) 10(1):1–1. doi: 10.1016/J.IJSU.2021.105906

PubMed Abstract | CrossRef Full Text | Google Scholar

35. Brennan A, Blanchard S, Scharn B, Milbert K, Samuelson S. The need for accessibility in playgrounds for children with disabilities. Am J Occup Ther. (2016) 70(4_Supplement_1):7011505165p1. doi: 10.5014/AJOT.2016.70S1-PO6020

CrossRef Full Text | Google Scholar

36. Olsen HM, Dieser RB. “I am hoping you can point me in the right direction regarding playground accessibility”: a case study of a community which lacked social policy toward playground accessibility. World Leis J. (2012) 54(3):269–79. doi: 10.1080/04419057.2012.702456

CrossRef Full Text | Google Scholar

37. Parker R, Al-Maiyah S. Developing an integrated approach to the evaluation of outdoor play settings: rethinking the position of play value. Children's Geographies. (2022) 20(1):1–23. doi: 10.1080/14733285.2021.1912294

CrossRef Full Text | Google Scholar

38. Perry MA, Devan H, Fitzgerald H, Han K, Liu LT, Rouse J. Accessibility and usability of parks and playgrounds. Disability and health journal. (2018);11(2):221–9. doi: 10.1016/J.DHJO.2017.08.011

PubMed Abstract | CrossRef Full Text | Google Scholar

39. Rocha AN, Desidério SV, Massaro M. Accessibility evaluation of the playground during the play of children with cerebral palsy in school. Revista Brasileira de Educação Especial. (2018) 24:73–88. doi: 10.1590/S1413-65382418000100007

CrossRef Full Text | Google Scholar

40. Yantzi NM, Young NL, Mckeever P. The suitability of school playgrounds for physically disabled children. Children's Geographies. (2010) 8(1):65–78. doi: 10.1080/14733281003650984

CrossRef Full Text | Google Scholar

41. City of Tempe. Tempe Inclusive Playground Guide. 2019. https://www.tempe.gov/home/showpublisheddocument/73961/636927577427600000

42. New South Wales Government. Everyone can play: A guideline to create inclusive playspaces. (2019).

43. Ontario Parks Association. Playability tool kit: building accessible playspaces. (2001).

44. Play Wales. Creating accessible play spaces - a toolkit. (2017). https://issuu.com/playwales/docs/creating_accessible_play_spaces

45. South Australian Government. Inclusive play: Guidelines for accessible playspaces. (2019).

46. Morgenthaler T, Schulze C, Pentland D, Lynch H. Environmental qualities that enhance outdoor play in community playgrounds from the perspective of children with and without disabilities: a scoping review. Int J Environ Res Public Health. (2023) 20:1763. doi: 10.3390/ijerph20031763

PubMed Abstract | CrossRef Full Text | Google Scholar

47. Ross T, Arbour-Nicitopoulos K, Kanics IM, Leo J. Creating inclusive playgrounds: a playbook of considerations and strategies. Holland Bloorview Kids Rehabilitation Hospital. (2022). Available at: www.hollandbloorview.ca/playgroundsplaybook

Google Scholar