(PDF) Education and Inclusion of Children with Special Educational Needs and Disabilities in Physical Education Classes

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Education and Inclusion of Children with Special

Educational Needs and Disabilities in Physical

Education Classes

Giampiero Tarantino, B.Sc., M.Sc.

18204976

This thesis is submitted to University College Dublin in fulfilment of the requirements for the degree of

Doctor of Philosophy in the School of Public Health, Physiotherapy and Sports Science.

Supervisor: Dr Ross D Neville

Head of School: Prof. Catherine Blake

Doctoral Studies Panel: Dr James Matthews, Dr Carla Perrotta, Dr Ross D Neville

September 2022

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Table of Contents

Preface .................................................................................................................... vii

Publications forming part of this thesis ............................................................................ vii

Presentation arising from work in this thesis ..................................................................... xi

Co-authored publications not forming part of this thesis ................................................. xiii

Declaration ............................................................................................................. xiv

Acknowledgements .................................................................................................. xv

List of Abbreviations ............................................................................................... xvii

List of Figures ........................................................................................................ xviii

List of Tables ............................................................................................................ xx

Chapter 1: Theoretical Overview ............................................................................... 1

1.1 Background ................................................................................................................. 1

1.2 Inclusive Education and the Irish Context .................................................................... 4

1.2.1 Becoming a PE teacher in Ireland .............................................................................................. 7

1.3 Aims and objectives of this thesis. ............................................................................... 8

1.4 References ................................................................................................................ 13

Chapter 2: Inclusion of children with special educational needs and disabilities in

physical education: A systematic review and meta-analysis of teachers’ attitudes. . 23

2.1 Abstract ..................................................................................................................... 23

2.2 Introduction .............................................................................................................. 24

2.3 Aims .......................................................................................................................... 25

2.4 Method ..................................................................................................................... 26

2.4.1 Inclusion and Exclusion Criteria ............................................................................................... 26

2.4.2 Databases and Search Strategy ............................................................................................... 27

2.4.3 Risk of bias ............................................................................................................................... 27

2.4.4 Data Extraction, Synthesis, and Analysis ................................................................................. 33

2.4.5 Meta-Analysis of Cross-Sectional Studies ................................................................................ 33

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2.5 Results ...................................................................................................................... 34

2.5.1 Quantitative Studies ................................................................................................................ 36

2.5.2 Qualitative Studies .................................................................................................................. 46

2.6 Discussion ................................................................................................................. 54

2.6.1 Reflections on the Evidence .................................................................................................... 54

2.6.2 Implications of the Evidence ................................................................................................... 57

2.7 Conclusion ................................................................................................................. 60

2.8 Notes ........................................................................................................................ 60

2.9 References ................................................................................................................ 61

Chapter 3: Teachers Attitudes’ Towards Inclusion in Physical Education: Systematic

Review and Meta-Analysis of Studies Conducted Before and After the Salamanca

Statement ............................................................................................................... 71

3.1 Abstract ..................................................................................................................... 71

3.2 Introduction ........................................................................................................... 72

3.3 Materials and Methods ............................................................................................. 73

3.3.1 Search strategy ........................................................................................................................ 73

3.3.2 Inclusion Criteria ...................................................................................................................... 74

3.3.3 Exclusion Criteria ..................................................................................................................... 75

3.3.4 Risk of bias ............................................................................................................................... 75

3.3.5 Data Extraction ........................................................................................................................ 75

3.3.6 Meta-Analytic Approach .......................................................................................................... 75

3.4 Results ...................................................................................................................... 76

3.4.1 Characteristics of the Studies .................................................................................................. 78

3.4.2 Overview of Studies’ Risk of Bias ............................................................................................. 85

3.4.3 Meta-analysis .......................................................................................................................... 85

3.5 Discussion ............................................................................................................. 87

3.6 Limitations ................................................................................................................ 89

3.7 Directions for future research .................................................................................... 89

3.8 Conclusion ................................................................................................................. 91

3.9 Notes ........................................................................................................................ 92

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3.10 References .............................................................................................................. 93

Chapter 4: Factors Associated with Irish Teachers’ Attitudes Towards the Inclusion of

Children with Disabilities and Special Educational Needs in Physical Education ..... 102

4.1 Abstract .................................................................................................................... 102

4.2 Introduction .......................................................................................................... 103

4.3 Materials and Methods ........................................................................................ 106

4.3.1 Research design and participants .......................................................................................... 106

4.3.2 Measures ............................................................................................................................... 106

4.3.3 Outcome Variables ................................................................................................................ 107

4.3.4 Independent Variables .......................................................................................................... 109

4.3.5 Statistical analyses ................................................................................................................. 110

4.4 Results ................................................................................................................... 111

4.4.1 Descriptive Statistics .............................................................................................................. 111

4.4.2 Analysis of the predictors on the outcome variables ............................................................ 114

4.5 Discussion ................................................................................................................ 122

4.6 Strengths and Limitations ......................................................................................... 125

4.7 Conclusion ................................................................................................................ 126

4.7 References ............................................................................................................... 128

Chapter 5: Associations between Physical Education Teachers’ Attitudes towards

Inclusion, Self-Efficacy to Deliver Inclusive Pedagogy, and Perceptions about the School

Context within which They Work: A Confirmatory Model ....................................... 135

5.1 Abstract .................................................................................................................... 135

5.2 Introduction ............................................................................................................. 137

5.2.1 Study purpose and hypothesised model ............................................................................... 140

5.3 Materials and Methods ............................................................................................ 143

5.3.1 Research design and participants .......................................................................................... 143

5.3.2 Measures ............................................................................................................................... 143

5.3.3 Statistical analyses ................................................................................................................. 146

5.4 Results ..................................................................................................................... 147

5.4.1 Descriptive statistics .............................................................................................................. 147

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5.4.2 Confirmatory factor analysis ................................................................................................. 149

5.4.3 Further exploratory factor analysis ....................................................................................... 150

5.5 Discussion ................................................................................................................ 154

5.6 Strengths and limitations .......................................................................................... 158

5.7 References ............................................................................................................... 160

Chapter 6: Final Discussion and Future Directions .................................................. 166

6.1 Introduction ............................................................................................................. 166

6.2 Research Questions 1 and 2. ..................................................................................... 168

6.3 Research Questions 3 and 4. ..................................................................................... 172

6.4 Limitation and Direction for Future Research ........................................................... 174

6.5 References ............................................................................................................... 178

Appendixes ........................................................................................................... 186

Appendix 1. String used for the search strategy in Chapter 2. ......................................... 186

Appendix 2. Copy of the questionnaire delivered to the Irish PE teachers in June 2020. . 187

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Abstract

The inclusion of children with special educational needs and disabilities

(SEND) in mainstream education has become a global priority over the past 40

years. The first public law – The Education for All Handicapped Children Act,

published in 1975 in the United States, made an unequivocal case for the rights

of children with disabilities to access education alongside their peers as equals.

Since then, global awareness of the education of children with SEND has led to

the development of national and international policies aimed to promote and

support the education of such children in mainstream schools.

A subfield of education that has been consistently acknowledged as a

primary opportunity for encouraging and promoting inclusion within schools is

physical education (PE). PE not only provides opportunities for SEND children to

be physically active, but it also provides meaningful engagement and interactions

with other children that can benefit the psychosocial development of children with

SEND profiles. Despite such opportunities, the research evidence has also

consistently shown that children with SEND profiles are still not fully included in

PE classes. As such, researchers have widely investigated the barriers and

facilitators to the inclusion of SEND children in PE, reporting that teachers’

attitudes are one of the most important barriers and proximal factors influencing

inclusion. Research has also shown that other factors can also potentially affect

teachers’ likelihood of practising and implementing inclusive PE – such as

teachers’ perceived self-efficacy, and also the nature of the school context within

which they work..

The aim of this thesis was threefold, to: (i) systematically review and

synthesise the literature on PE teachers’ attitudes towards inclusion the inclusion

of SEND children within PE; (ii) investigate the factors influencing Irish PE

teachers’ attitudes and wider perceptions about the inclusion of SEND children in

PE lessons; and (iii) test and confirm, for the first time, a structural model of

inclusion in PE that brings together teachers’ attitudes, self-efficacy, and

perceptions about the school context within which teachers work.

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The findings of this thesis indicated that teachers have largely favourable

attitudes toward the inclusion of children with SEND in PE, and that experience

working with children with SEND was positively associated with such favourable

attitudes. The findings of this thesis also indicate that a wide range of different

factors affect teachers’ attitudes – including, knowledge and preparation, years

of teaching experience, direct experience working with SEND children, type, and

degree of SEND, and collaboration and teaching support. Within the Irish

context, the findings this thesis revealed specifically that having different types of

disabilities within the class positively influenced Irish PE teachers’ attitudes

toward inclusion. This suggests that exposing teachers to students with diverse

profiles promotes favourable attitudes toward the inclusion of otherwise

marginalised population groups within PE. The findings of this thesis also suggest

that Irish secondary school PE teachers have higher perceived self-efficacy

levels than their counterparts working in primary schools. This suggests that

components of the secondary-level pre-service curricula may have a positive

influence self-efficacy in delivering inclusive pedagogies (and that further

promotion of such components is required in pre-service education for primary-

level teachers). The findings of a structural model of inclusion reported in this

thesis also showed positive and significant associations between Irish PE

teachers’ (i) attitudes toward the inclusion of SEND children, (ii) self-efficacy in

delivering inclusive pedagogies, and (iii) perceptions about the school within

which they worked. This suggests that the attitudes of Irish teachers towards the

inclusion of children with SEND profiles in PE are embedded within wider initial

education and professional learning and development needs, and also related

closely to the norms that inclusion policy and practice at a wider school level.

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Preface

Publications forming part of this thesis

Chapter 2: Tarantino, G., Makopoulou, K., and Neville, R. D. (2022). Inclusion of

children with special educational needs and disabilities in physical education: A

systematic review and meta-analysis of teachers’ attitudes. Educational

Research Review, 36(100456). doi:10.1016/j.edurev.2022.100456

Author

Contribution

Giampiero Tarantino

Study conception and design,

study execution, data extraction,

analyses, and interpretation; draft,

write, review, and submission of

the manuscript.

Kyriaki Makopoulou

Review of the manuscript.

Ross D Neville

Supervision of study conception

and design, data interpretation;

revision, and review of the

manuscript.

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Chapter 3: Tarantino, G., Makopoulou, K., and Neville, R. D. (2022). Teachers’

Attitudes Towards Inclusion in Physical Education: Systematic Review and Meta-

Analysis of Studies Conducted Before and After the Salamanca

Statement. International Journal of Inclusive Education. Currently under review

Author

Contribution

Giampiero Tarantino

Study conception and design, study

execution, data extraction, analyses,

and interpretation, draft, write,

review, and submission of the

manuscript.

Kyriaki Makopoulou

Review of the manuscript.

Ross D Neville

Study conception and design, data

analyses and interpretation, write,

and review of the manuscript.

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Chapter 4: Tarantino, G. and Neville, R. D. (2022). Factors Associated with Irish

Teachers’ Attitudes Towards the Inclusion of Children with Disabilities and

Special Educational Needs in Physical Education. Irish Educational Studies.

Currently under review

Author

Contribution

Giampiero Tarantino

Study conception and design, study

execution, data extraction, analyses,

and interpretation, draft, write,

review, and submission of the

manuscript.

Ross D Neville

Study conception and design, data

analyses and interpretation, write,

and review of the manuscript.

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Chapter 5: Tarantino, G. and Neville, R. D. (2022). Associations between

Physical Education Teachers’ Attitudes towards Inclusion, Self-Efficacy to Deliver

Inclusive Pedagogy, and Perceptions about the School Context within which

They Work: A Confirmatory Model. European Physical Education Review.

Currently under review

Author

Contribution

Giampiero Tarantino

Study conception and design, study

execution, data extraction, analyses,

and interpretation, draft, write,

review, and submission of the

manuscript.

Ross D Neville

Study conception and design, data

analyses and interpretation, write,

and review of the manuscript.

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Presentation arising from work in this thesis

Tarantino G, Neville R (2022). Teachers Attitudes Towards Inclusion in Physical

Education: Systematic Review and Meta-Analysis of Studies Conducted Before

and After the Salamanca Statement. European Conference on Educational

Research Conference, Yerevan, Armenia, 23 – 26 August 2022.

Tarantino G, Neville R (2022). Associations between Physical Education

Teachers’ Attitudes towards Inclusion, Self-Efficacy to Deliver Inclusive

Pedagogy, and Perception about the School Context within They Work: A

Confirmatory Model. International Association for Physical Education in Higher

Education Conference, Gold Coast, Australia, 15 – 18 June 2022 (online).

Tarantino G, Neville R (2022). Associations between Physical Education

Teachers’ Attitudes towards Inclusion, Self-Efficacy, and Perception about the

School Context: A Confirmatory Model. UCD CHAS Inaugural Graduate

Research Student Symposium, Dublin, 8th April 2022.

Tarantino G, Neville R (2020). Inclusion of children with special educational

needs and disabilities in physical education: a systematic review and meta-

analysis of teachers’ attitudes. International Society of Behavioural Nutrition and

Physical Activity Conference, Auckland, online June – July 2020.

Tarantino G, Neville R (2019). Teachers’ attitudes toward inclusion of children

with special educational needs and disabilities in physical education classes:

findings from a systematic review. Irish Disabilities Studies Association Seminar,

Trinity College Dublin, Dublin, 11th December 2019.

Tarantino G, Neville R (2019). Teachers’ Attitudes towards the Inclusion of

Children with Special Educational Needs and Disabilities in Physical Education

Classes: Preliminary Findings from a Systematic Review. British Educational

Research Association Conference, Manchester, 10 – 12 September 2019.

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Tarantino G, Neville R (2019). What do teachers think about included children

with special educational needs and disabilities in physical educational classes?

Preliminary analysis based on a systematic review. International Society of

Behavioural Nutrition and Physical Activity Conference, Prague, 4 – 7 June 2019.

Tarantino G, Neville R (2019). Factor Affecting the Inclusion of Children with

Disabilities in Physical Education Lessons: A Study of Irish Teachers Attitudes.

UCD CHAS Inaugural Graduate Research Student Symposium, Dublin, 14th

March 2019.

xiii

Co-authored publications not forming part of this thesis

Niranjan V, Tarantino G, Kumar J, Stokes D, O’Connor R, O’Regan A. The

Impact of Dance Interventions on Patients with Non-Infectious Pulmonary

Diseases: A Systematic Review. International Journal of Environmental

Research and Public Health (2022). doi:10.3390/ijerph191711115

Neville RD, Lakes KD, Hopkins WG, Tarantino G, Draper C, Beck RM, Madigan

S. Global Changes in Child and Adolescent Physical Activity During the COVID-

19 Pandemic: A Systematic Review and Meta-analysis. JAMA Pediatr. Published

online July 11, 2022. doi:10.1001/jamapediatrics.2022.2313

O’Brien, W., Khodaverdi, Z., Bolger, L., Tarantino, G., Philpott, C., Neville RD.

The Assessment of Functional Movement in Children and Adolescents: A

Systematic Review and Meta-Analysis. Sport Medicine (2021).

doi:10.1007/s40279-021-01529-3

Valli G, Minnock D, Tarantino G, Neville RD. Delayed effect of different exercise

modalities on glycaemic control in type 1 diabetes mellitus: a systematic review

and meta-analysis. Nutrition, Metabolism and Cardiovascular

Diseases (2020). doi:10.1016/j.numecd.2020.12.006

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Declaration

I hereby declare that I am the sole author of this thesis. The work herein is entirely

my own unless otherwise clearly indicated and acknowledged. I can confirm that

this thesis has been submitted for the degree of Doctor of Philosophy and no part

of this work has been submitted for any other degree or professional qualification.

Giampiero Tarantino

September 2022

xv

Acknowledgements

I am deeply thankful to my supervisor, Dr Ross Neville, for giving me the

opportunity to pursue my PhD degree. Ever since I met him, in October 2017, his

guidance, help, and supervision have been fundamental to my journey. I want to

thank him for believing in me and helping me to become the researcher that I am

today. Our endless meetings chatting about statistics will not be soon forgotten,

as well as our coffee breaks at Pi. I am also grateful to Dr Ross Neville for the

precious and invaluable support that he provided during the challenging times

that Covid-19 brought to our lives. I finally want to thank him for trusting me in the

supervision of Bachelor students, and in the delivery of undergraduate modules.

In this regard, I would like to thank the Irish Research Council for funding this

PhD project and giving me the opportunity to conduct this research in the beautiful

and welcoming Ireland.

I would also like to thank my Doctoral Study Panel members, Dr Carla Perrotta

and Dr James Matthews. During my PhD project, their help has been invaluable.

They have always believed in me, and their guidance has been vital for my

research project. I am also deeply grateful to Dr Carla Perrotta for making me

love the systematic review design and for having asked me to teach this research

method to undergraduate and master's students. Since I took her module, I have

found in the systematic review approach a research method that I will hardly

shelve.

I special thank goes to the Woodview House and the people who work (or have

worked) there that I have met during the last years. In particular, I would like to

thank: Dr John Shuttleworth for the endless conversations about rugby, politics,

and sociology; Dr Conor Buggy for his precious advice; and Dr Olive Lennon for

helping me to set up the first Postgraduate Research Student Committee, which

I have proudly chaired. In this sense, I would like to thank the members of the

committee: Shevaun, Fiona, Michelle, Eoin, and Maria. Your help has been

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fantastic and working with you has been an immense privilege. I would also like

to thank Dr Tara Cusack for having organised the CHAMELEONS project, a

fantastic 2-year experience during which I met amazing people: Niamh, Hiten,

Débora, Marylin, Fiona (already mentioned), Guido, and many others.

A special mention goes to Dr Cale Lawlor who, from being just a colleague,

became one of my closest friends in Dublin. Since he left UCD, Room F18 in

Woodview House is not the same anymore, but I am grateful we still share pints,

gigs, food, and meaningful chats.

Special thanks go to my mentor, Emeritus Prof Roy McConkey OBE, from Ulster

University. Ever since we met, we have shared many chats, coffees, and walks,

to such an extent that I now consider him a good friend, rather than a mentor. His

expertise has been extremely precious to my PhD journey, and I will always be

grateful to him for his support and friendship.

My thanks also go to Cristina and Elisa who were the first people that I met at

UCD and quickly became close friends of mine. I would like to thank you both for

bearing and supporting me over the past years, especially during our lunches at

Pulse Café. A special mention is also for my friend Luis, whom I met thanks to

Elisa. I would like to thank him for answering all the statistical questions that I

have asked him over the years. Thankfully, our friendship also involves watching

rugby (preferably at the Aviva Stadium or at the RDS Arena), beers, and many

other common interests!

Finally, I would like to thank my family: my mom, my dad, and my sister Paola in

particular. Despite being almost 2,500km far, I have always felt your support

being close. Thanks for having always believed in me and supported me even

during the most challenging times.

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List of Abbreviations

CFA: Confirmatory Factor Analysis

EPSEN: Education for Persons with Special Educational Needs

PA: Physical Activity

PE: Physical Education

SEND: Special Educational Needs and Disabilities

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List of Figures

Figure 2.1. Flow diagram of the studies included in the systematic

review

p. 35

Figure 2.2. Meta-analysis of the weighted standardized mean

differences across studies. The vertical line represents the overall

mean (zero). CI, confidence interval.

p. 41

Figure 2.3. Meta-analysis of the weighted standardized mean

differences between males and females. The vertical line represents

no differences between the compared groups. CI, confidence interval.

p. 41

Figure 2.4. Meta-analysis of the weighted standardized mean

differences between teachers with and without direct experience

working with SEND children. The vertical line represents no

differences between the compared groups. CI, confidence interval.

p. 42

Figure 2.5. Venn Diagram of the themes emerged from the qualitative

and the quantitative syntheses.

p. 47

Figure 3.1. Flow Diagram of the Studies Included in the Meta-

Analysis.

p. 77

Figure 3.2. Subgroup analysis of studies conducted before and after

the Salamanca Statement (1994). The vertical line represents the

neutral mean (zero). CI, confidence interval.

p. 86

Figure 5.1. Domains of attributes impacting the inclusion of children

with disabilities in PE according to Hutzler et al. (2019).

p. 139

Figure 5.2. Hypothesised model.

p. 142

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Figure 5.3. Confirmatory Factor Analysis of the latent variables.

Standardised path coefficients shown. Significance denoted * p < .05,

** p < .01, *** p < .001. Dotted paths represent non-significant

associations.

p. 151

Figure 5.4. Confirmatory Factor Analysis after removal of ‘Needs’.

Standardised path coefficients shown. Significance denoted * p < .05;

** p < .01; *** p < .001. Dotted paths represent non-significant

associations.

p. 153

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List of Tables

Table 2.1. Risk of Bias Assessment for the Qualitative Studies.

p. 28-29

Table 2.2. Risk of Bias Assessment for the Quantitative Studies.

p. 30-31

Table 2.3. Studies Included in the Quantitative Synthesis.

p. 37-39

Table 2.4. Summary of the effect sizes reported in the studies

that investigated the association between teachers’ attitudes

towards based on type of SEND.

p. 43

Table 2.5. Summary of the Quantitative Studies Results.

p. 45

Table 2.6. Summary of the Themes Emerged from the Analysis

of the Qualitative Studies.

p. 48

Table 3.1. Characteristics of the Studies Included in the Meta-

Analysis.

p. 79-81

Table 3.2. Risk of Bias Assessment for the Studies Included in

the Meta-analysis.

p. 82-84

Table 4.1. Participants’ and schools’ characteristics.

p. 112-113

Table 4.2. Effect sizes.

p. 116-121

Table 5.1. Teachers’ characteristics.

p. 148

Table 5.2. Descriptive statistics.

p. 149

Table 6.1. Number or primary, secondary, and special schools

and pupils respectively enrolled in each type of school in the

Republic of Ireland from 2011/2012 to 2021/2022.

p. 171

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Chapter 1: Theoretical Overview

1.1 Background

The global incidence of physical inactivity is substantial across the world

(WHO, 2006), and its burden is considerable. It is the fifth leading cause of death

worldwide and it is estimated to cost in the region $50 billion annually due to

chronic disease and lost productivity (World Health Organization, WHO, 2003).

In this context, promoting healthy active lifestyles has become a global health

priority in need of interdisciplinary research. One area where research is lacking,

however, is in relation to the physical activity needs and supports children with

special educational needs and disabilities (SEND

1

). Research shows that SEND

children are disproportionately negatively affected by health conditions related to

physical inactivity (Collins and Staples, 2017; Pan, Liu, Chung, and Hsu, 2015;

Rimmer and Rowland, 2008) and that children with SEND profiles are at

considerable risk of failing to achieve the recommended levels of physical activity

(PA) which would ensure good health (Stevens et al., 2010; Whitt-Glover et al.,

2006).

1

In the international literature, and also in educational policy and practice, slightly different

terminology has been used to refer to children with special educational needs and disabilities. For

example, the abbreviation SEN has been used to categorise children with special educational

needs (which may or may not include a learning difficulty associated with a disability), and SEND,

SEN-D, and SEN/D to categorise children with special educational needs and/or disabilities. In

Ireland, the National Council for Special Education formally uses the abbreviation SEN, and the

term SEN is used in the recently published Policy Framework for Children and Young People

2023-2028 (Herron, Fullerton, and McGrellis, 2022). The abbreviation SEN has also historically

been used in the United Kingdom in local government documentation pertaining to Education,

Health, and Care Plans for children with a formal statement of special educational needs (the

statutory basis for such terminology being provided for under the Children and Families Act 2014).

In more recent documentation – including substantial documentation of public consultation

activities in this area, and a 2022 Office for Standards in Education framework and guidance

handbook for inspecting schools in related to fulfilling their statutory obligations (which is available

the main publicly-funded citizen information website in the UK [GOV.UK, 2022]) – the broader

term SEND is consistently used. A less formal and more pragmatic rationale for using the broader

term SEND was initially employed for this thesis: that is, whilst in other school subjects, having a

disability might not necessarily be a barrier at all to learning and even high achievement (e.g.,

English or in Maths), in practice in PE, it is almost always the case that having a disability will

much more directly (even if only initially) affect a child’s engagement in planned learning activities

and achievement of learning outcomes. As such incorporating the term disability into the

framework of special educational needs that form the practice expectations and experiences of

PE teachers seemed both natural and appropriate to the needs of this specific thesis.

2

The health benefits of PA are well documented among children with

SEND. For this very reason, researchers, child health practitioners and

advocates, and policymakers strongly recommend SEND children to be

physically active and, more specifically, to meet the WHO guidelines of 60

minutes per day of moderate-to-vigorous PA across the week, with at least three

days of vigorous-intensity aerobic activities per week (WHO, 2020). Such levels

of PA have been reported as promoting physical health among children,

regardless of their ability level, and it has also been consistently reported as

having positive effects on their mental health (Ginis et al., 2021). Evidence has

shown that participating in PA is positively associated with intrapersonal factors

such self-perception, self-efficacy, self-esteem, and confidence (Ahn and

Fedewa, 2011; Martin, 2013). Research has shown that these benefits can also

equally occur among children with SEND – engaging in PA can increase affect

(Jin et al., 2018; Palisano et al., 2011), self-concept and perceptions of self (Batey

et al., 2014; Ng et al., 2014; Te Velde et al., 2018), as well as mental health and

overall wellness (Brunes et al., 2015; Giese et al., 2017, Puce et al., 2019). More

specifically, PA has also been shown to reduce SEND condition-related levels of

anxiety and depression (Brunes et al., 2015; Fiorilli et al., 2016; Gaweilow et al.,

2016; Whitney et al., 2019a; Whitney et al., 2019b), as well as condition-related

fatigue (Maher et al., 2015). A recent meta-analysis has even reported substantial

positive effects of PA on mental health in children and adolescents with

intellectual disabilities – with moderate-sized effects on psychological health and

large-sized effects on cognitive function (Yang, Liang, and Sit, 2022). Despite the

well-documented benefits of PA for children with SEND children’s health, their

engagement in PA tends to be considerably and consistently lower than their so-

called typically-developing peers (Corvey et al., 2016; McGarthy et al., 2018; Sit

et al., 2020; Li et al., 2021).

An area that has been acknowledged to be a key setting for delivering and

promoting high-quality PA is physical education (PE). PE is the most common

method to deliver quality PA (Hills et al., 2015) and provides, at minimal costs

(Erwin et al., 2014), opportunities for students to obtain knowledge and develop

the abilities needed to establish and maintain active lifestyles during childhood,

3

adolescence, and into adulthood (Lee et al., 2007). Engagement in PE is known

to strongly complement (as opposed to negatively interfere with) the academic

performance of school students (Trudeau and Shephard, 2008), and it also has

been shownd to increase students’ daily PA participation and health (Morgan et

al., 2007). It has been shown that school-based physical activity programmes,

such as PE, can directly predict SEND children’s health and their daily PA

engagement (Jin et al., 2018). Morgan et al. (2007) have shown, specifically, that

during the days in which students had PE classes, they accumulated more daily

steps compared to those days in which they did not have PE lessons.

Furthermore, PE has been also widely identified as a setting which provides a

microcosm of the complex interactions and relationships that strengthens SEND

students’ interpersonal and social skills (Butler, 2006). Finally, PE has been

described, by students with SEND, to be a pleasant, friendly, and respectful

setting in which they can establish and nurture positive socially active

relationships (Butler and Hodge, 2004; Goodwin, 2001; Seymour, Reid, and

Bloom, 2009)

The inclusive setting that PE can provide, with emphasis on valuing and

respecting diversities, encourage and promote students’ engagement (Keddie

2012; Lingard 2005), and creates a ‘meaningful and authentic learning

experience’ (Overton et al., 2017, p. 420). Despite the potential role of PE as a

pivotal setting for providing key activity opportunities to students with SEND

profiles, their inclusion in PE classes is still not effective (Sit et al., 2017). Despite

the opportunities to be more engaged and physically and mentally healthy within

PE exist, a recent qualitative review highlighted the fact that SEND students

experience PE classes as unsuitable or inadequate to their needs (Rekka et al.,

2019). Since one of the proffered benefits of PE is its pedagogical flexibility and

the ability of teachers to adapt lessons to meet the activity preferences of a given

class of pupils, in principle, PE has been recognised as an excellent setting for

including children with so-called ‘additional needs’, including children with SEND

profiles (Berg and Kokkonen, 2021). However, inclusion in PE is not still fully

achieved (Sit et al., 2017) and SEND pupils’ progression in PE is hampered by a

lack of appropriateness in the design of the class activities which are seldom

4

based on their abilities or needs. Furthermore, pupils’ dissatisfaction and

disengagement from PE are associated with a consistent failure among practising

teachers to remediate such design or tailor provision based on their abilities (Sit

et al., 2017).

In the context of PE, barriers to inclusion have been widely investigated,

with research drawing attention to the significance and the importance of

teachers’ attitudes (Elliot 2008). Teachers’ attitudes were, in fact, initially

identified by researchers as the key proximal factor affecting the inclusion of

children with SEND (Patrick 1987; Rizzo 1984; Rizzo and Wright 1988; Rowe and

Stutts 1987) and they are still deemed to be central and relevant nowadays

(Robinson 2017; Sharma and Nuttal 2014). A large body of literature has

investigated the impact of PE teachers’ attitudes on the inclusion of students with

SEND profiles, with findings reporting a wide range of factors affecting attitudes.

Qualitative findings from these reviews reported that one of the main factors

influencing attitudes was the pre- and in-service training, which was deemed to

be ineffective, or not acknowledged to be as formative for teachers to impact their

attitudes towards inclusion of their abilities vis-à-vis inclusive practice attitudes

(Block and Obrusnikova 2007; Qi and Ha 2012; Tant and Watelain 2016). PE

teachers’ attitudes have historically been the focus of research within the Irish

context. However, there is a lack up-to-date research evidence regarding whether

the changes employed over the past decades by the Irish Educational system,

following the global consensus toward inclusive education, have impacted

teachers’ attitudes.

1.2 Inclusive Education and the Irish Context

Researchers have proposed and used different definitions of inclusive

education over the past five decades. For example, Goodall (2015) defined it as

a means of providing every child with an equal opportunity to learn in a

mainstream setting, regardless of their level of ability. Such a definition of

inclusion involves adapting the classroom and the school environment to meet

the needs of the child so that they can be educated alongside their typically-

developing peers as equals. Earlier, DePauw and Doll-Tepper (2000, p. 139)

defined inclusion as ‘a systemic and philosophical approach for implementing

5

social justice in our schools and our society so that all persons are valued as

unique contributing members of society and included’. Whilst there is much

debate about how to define inclusion in the broad field of education, the discourse

on defining inclusive PE is somewhat less contentious. Inclusion in PE classes

has recently been comprehensively defined as a the ‘construction of rich learning

environments where all students, regardless of gender, (dis)ability, social class,

and race/ethnicity, can experience agency, success, and joy through bodily

movement’ (Nabaskues-Lasheras et al., 2020, p. 866). According to Nabaskues-

Lasheras and colleagues, inclusion in PE requires: (i) respecting and celebrating

individual differences; (ii) fair and equitable distribution of the benefits of PE; and

(iii) viewing each pupil as an individual, instead of seeing a class primarily as a

collective group (Nabaskues-Lasheras et al, 2020, p. 866).

In the past, children with SEND profiles in Ireland were segregated in

special schools or special classrooms and kept separated from their peers

without SEND (McDonnell 2003). This categorical view – based on the view that

‘normal’ children attending mainstream schools and their SEND peers should be

catered for in separate schools or classrooms – has been predominant in Ireland

for decades (Shevlin et al., 2002). However, with the introduction of the Education

for Persons with Special Educational Needs Act 2004, Ireland committed to

pursuing an educational system that, whenever possible, supports an inclusive

environment where pupils with SEND profiles are embraced within the

mainstream school setting (Government of Ireland, 2004). The focus of the Irish

educational system, therefore, shifted from segregated educational norms to a

more inclusive educational approach (Drudy and Kinsella, 2009). However, in

contrast with the objectives of the educational system and the definition of

inclusive education, inclusion in Ireland still seems to be a considerable practical

challenge. A potential signal of this challenge can be found by identifying and

scrutinising the number of special classes in operation in Ireland. On the one

hand, more than half a decade ago, McConkey et al. (2016) reported that

between 2003 and 2013 a slow increment of students with intellectual disabilities

in mainstream schools occurred in the Republic of Ireland. On the other hand,

much more recently, Shevlin and Banks (2021) found that the number of special

6

classes in operation has increased from just over 700 classes to almost 1,800

classes over the past decade (Shevlin and Banks, 2021). Although these classes

are primarily designed to accommodate students with autism spectrum disorders,

this number raises concerns regarding the efficiency of the inclusive educational

setting in Ireland.

Although it has been suggested that Ireland has a more developed

framework for inclusive practice than in other European countries (Marron and

Morris, 2018), research on the inclusion of SEND children in education in Ireland

has been extremely limited. This lack is even more evident in relation to PE. The

few studies that have been conducted and published in relation to the inclusion

of SEND children in PE have focused primarily on either on pre- or in-service

teachers’ attitudes and self-efficacy, which still seem to be the main barriers to

inclusion (Meegan and MacPhail, 2006; Tindall et al., 2016). However,

characteristics of the PE setting also seem to provide challenges to the facilitation

truly inclusive PE. In Ireland, PE activities remain primarily dominated by team

sports, particularly invasion games (Woods et al., 2010). Research evidence

shows that such activities lead to further marginalisation, indicating that an over-

emphasis on competition in PE – i.e., on winning and losing, and critically, on

winners and losers – further hampers the inclusion of students with SEND profiles

(Hodge et al., 2004; Vickerman and Coates, 2009). For example, such an activity

setting can inhibit SEND children from making progress in PE because athletic

performance is taken as the main indicator of subject knowledge and learning.

Such a view falls within the broader picture that the school environment in

which teachers work influences their practices vis-à-vis inclusion – and that

previous research on inclusion in Ireland which focuses on attitudes and efficacy

beliefs needs to be extended. Research has extensively shown that individuals

belonging to the same school tend to have similar attributes and beliefs compared

to teachers from different schools (Caprara et al., 2006). In this regard, the school

context may also play an important role in shaping and influencing Irish teachers’

attitudes and, ultimately, the inclusion of SEND students in PE. Inclusion requires

attitudinal change among school staff and administrators also – i.e., commitment

to a shared culture of inclusion. It requires innovative pedagogies that should be

7

used by teachers to foster open and inclusive activity environments in PE and

school sports. Neither of these enablers of inclusion is currently the norm within

schools, however, for several reasons. Despite the importance that the school

environment has on inclusion, it has rarely been investigated internationally and

(to the researchers’ knowledge) never investigated before in the Irish context.

1.2.1 Becoming a PE teacher in Ireland

PE teachers are educators who specialise in the instruction and guidance

within the subjects of physical health, development, proper nutrition and sports

participation. PE teachers work closely with students of all ages and educate

them in health and sports science topics in which functional movement and

physical activities are nurtured, developed and assessed. Formally, becoming a

‘PE teacher’ in Ireland means becoming a secondary school teacher. The most

direct route to become a PE teacher requires completion of a Bachelor in Physical

Education, which, in Ireland, can be completed at higher education institutions,

including Dublin City University, University of Limerick, University College Cork,

Institute of Technology of Tralee, Athlone Institute of Technology, the Portobello

Institute, and the Royal College of Surgeons in Ireland. As such, secondary

school PE teachers are the only teachers who hold a formal qualification to teach

PE in Ireland (this is also mostly the case in the UK). Professional Masters of

Education courses also provide Teacher Council of Ireland-approved graduate-

entry routes into teaching PE (i.e., where a person has a primary degree in an

area other than Education that aligns with at least one curricular subject within

the secondary school curriculum) (Teaching Council of Ireland, 2022). Indirect

routes to becoming a PE teacher in Ireland also now include successful

completion of a non-university course at a college of further education and

subsequently applying for ‘Access’ route entry to one of the higher education

institutions named above.

Whilst secondary school PE teachers obtain such formal qualifications to

teach PE, primary school teachers are typically trained to be educational

generalists, and, as such, PE represents only one among many subjects that they

are expected to deliver (Makopoulou et al, 2021; Neville et al., 2020). For this

8

reason, while Irish secondary school teachers provide PE as an integral part of

the post-primary education cycles, the provision of PE at a primary level is often

managed by external service providers, a practice that has become a common in

primary schools worldwide (Sperka and Enright, 2017a, 2017b; Williams and

Macdonald, 2014). Within the Irish context, primary PE classes are commonly

delivered by non-specialist classroom teachers, which commonly involves

providers such as sports’ coaches, parents, volunteers or, in some cases,

secondary school PE teachers (Mangione et al., 2020).

1.3 Aims and objectives of this thesis.

The overall aim of this dissertation was to investigate the inclusion of

students with SEND profiles in Irish PE classes. Although inclusive education has

been conceptualised in many ways, as stated in the paragraphs, researchers are

unanimous in their agreement with the definition provided by the UNESCO (2008)

that highlight inclusive education as the promotion of student participation and

reduction of exclusion from and for education, and as the presence, participation,

and achievement of all students, especially of those who are excluded or at risk

of marginalisation, including those with SEND (UNESCO, 2008). More broadly,

inclusive education can be described as the promotion of the school and a

principled approach to education and society for all (Amor et al., 2019). In this

context, exploring inclusion in the Irish PE context from different points of view

was necessary. The next sections briefly describe the aims of each chapter and

the gaps in the literature addressed. A more exhaustive description of the aims

and the gaps in the literature for each study are reported in the introductory

section of each chapter.

The first objective, which embraces chapters two and three of this

dissertation, was to review the literature regarding the teachers’ attitudes vis-à-

vis the inclusion of children with SEND in PE. As teachers’ attitudes have been

highlighted as one of the most important barriers to inclusion, one aim of this

dissertation was to investigate the literature and assess the overall teachers’

attitudes and the potential factors that influence them. Although a few reviews

have been conducted in this context, there is a lack of quantitative evidence

9

synthesis. Recent reviews conducted in this field have primarily focused on

discursively synthesising qualitative evidence (Rekaa et al., 2019), and even

when quantitative approaches were used, only descriptive synthesis was

provided. (Wilhelmsen and Sørensen, 2017). Quantitatively reviewing the

literature was necessary for two reasons, to: (i) provide a and comprehensive

assessment of the strength of association between teachers’ attitudes and the

factors that influence them; and (ii) investigate whether and the degree to which

teachers’ attitudes have changed over time.

The second chapter of this dissertation used a systematic review approach

to investigate the current literature regarding PE teachers’ attitudes towards

inclusion. This approach was chosen because a clear and comprehensive

overview of the available evidence on this topic was necessary. This systematic

approach helped to identify the gaps in the literature and the methodological

concerns in the current research studies, with the overall objective to identify

questions and prompt future research. Given the disparate nature of the articles

available in this field, a mixed-methods systematic review was employed. The

objective was to include and synthesise research articles that employed both

qualitative and quantitative research methods to explore teachers’ attitudes.

Preliminary exploratory analysis of the included studies revealed that several

published articles used a validated questionnaire to investigate attitudes, which

prompted the utilisation of a meta-analytic approach to quantitatively synthesised

the findings. While meta-analyses on teachers’ attitudes have been previously

conducted in the general context of education, the meta-analyses provided in the

second chapter contribute to the first quantitative evidence, which has never been

conducted before, in the context of PE.

Visual inspection of the data in Chapter 2 (i.e., the meta-analysis forest

plots) prompted further consideration about whether and the degree to which

teachers’ attitudes towards inclusion had differed over time. As research in the

field of inclusive education has been carried out for more than three decades,

little is known about the influence of international consensuses on teachers’

attitudes. The ‘most important reference’ (Ainscow et al., 2019, p. 674), towards

which research is unanimous in acknowledging its influence on inclusive

10

education, is ‘The Salamanca Statement’ (Aniscow and César 2006; Magnùsson

2019; Pavone, Bellacicco, and Cinotti 2019; Aniscow, Slee, and Best 2019;

Gachago 2018; De Meulder, Murray, and McKee 2019; Snoddon and Murray

2019). During a World Congress in Spain, in June 1994, more than 300

participants representing 92 nations and 25 international organisations met in

Salamanca to develop and articulate policy changes to further promote inclusive

education in mainstream settings. Since then, qualitative research has regularly

reported the impact that the Salamanca Statement had on policy and practice in

inclusive education. As such, Chapter 3 of this thesis provides the first

quantitative evidence regarding the impact that the Salamanca Statement had on

PE teachers’ attitudes towards the inclusion of students with SEND profiles – do

PE teachers attitudes towards inclusion differ across time periods before and

after the publication of the Salamanca Statement? As such the main objective of

this chapter was to test and further support the view about change over time and

the potential impact of such macro-level policies on teachers’ attitudes.

The second objective of this dissertation was to investigate Irish PE

teachers’ attitudes. If the second chapter provides an overview of teachers’

attitudes and the variables that influence them, the fourth chapter specifically

focuses on this in the context of Irish teachers. This study was necessary for two

reasons. On the one hand, research on Irish PE teachers is scarce and the only

study investigating Irish PE teachers was conducted almost two decades ago

(Meegan and MacPhail, 2006). Since then, Ireland has employed changes to

address education rights for students with SEND allocating funding and

resources to schools (Kenny et al., 2020). Therefore, the main objective of this

study was to explore whether Irish PE teachers’ attitudes have changed over

time, and which factors influence them. On the other hand, the secondary

objective of this study was to explore the similarities and differences between

factors that influence Irish teachers’ attitudes compare to international evidence.

In this cross-sectional study, a questionnaire was sent out to Irish

teachers. In this sense, the mixed-methods systematic review conducted in the

second chapter provided a strong basis for developing the framework for this

study. Our findings from the systematic review revealed a variety of factors

11

influencing teachers’ attitudes, which enabled me to develop a more

comprehensive questionnaire for teachers. The study conducted by Meegan and

MacPhail (2006) only employed a questionnaire that included an attitudinal scale

and a teachers’ demographic section. To substantially develop on that

methodology, the questionnaire utilised in this study comprised: (i) a scale to

measure teachers’ attitudes toward including children with SEND; (ii) a scale

measuring teachers’ self-efficacy in delivering inclusive pedagogies to SEND

students; (iii) a scale developed to investigate the degree to which inclusion was

supported within the school in which teachers worked; (iv) a demographic section

exploring teachers’ characteristics; and (v) a section exploring schools’

characteristics. The utilisation of such a multi-faceted questionnaire enabled

wider exploration of the influence that the teachers’ and schools’ characteristics

have on Irish PE teachers’ attitudes, self-efficacy, and perceptions about the

school context. Given the theoretically justified known associations between

these three main constructs (Caprara et al., 2006; Fischer et al., 2018, Bandura

1977, Bandura, 1993), employing such a methodology was necessary to

comprehensively explore the factors that influenced Irish teachers.

The final objective of this dissertation was to explore the relationships

between Irish PE teachers’ attitudes and self-efficacy, and their perceptions of

the school context in which they worked. Research has widely shown the

influence that the school context has on teachers’ attitudes and self-efficacy

(Caprara et al., 2006; Fischer et al., 2018). Within the context of PE, researchers

have also argued the importance that the school factors might have on teachers’

behaviours towards inclusion (Morley et al. 2005). However, even though

hypotheses have been made and theoretical models have been widely utilised in

the field of inclusive PE (Hutzler et al., 2019), these relationships have never been

empirically investigated. These models have never been fully tested with real-life

data. As such, this thesis provides the first empirical test of such relationships

between these constructs within PE. Moreover, this is the first study that

investigates in such a manner the Irish context, providing a strong basis for future

research on inclusive physical education in Ireland. Data gathered through the

multi-scale questionnaire was used to for investigating the interactions between

12

Irish PE teachers’: (i) attitudes towards the inclusion of children with SEND

profiles; (ii) self-efficacy in providing inclusive pedagogies; and (iii) perceptions of

the degree to which inclusion was supported within the school in which they

worked.

1.3.1 Research Questions

The research questions addressed in each of the four empirical chapters

of this thesis are as follows:

1: Do teachers hold mostly favourable or unfavourable attitudes towards the

inclusion of SEND children in physical education? Which personal, professional,

social, and practical factors can potentially affect teachers’ attitudinal formation?

2: Are there differences in the direction and magnitude of PE teachers’ attitudes

towards the inclusion of children with SEND profiles for studies conducted before

and after the publication of the Salamanca Statement?

3: Do demographic attributes and the characteristics of the school in which they

work influence Irish PE teachers’ (i) attitudes towards the inclusion of children

with SEND profiles in mainstream PE classes; (ii) self-efficacy in delivering

inclusive pedagogies; and (iii) perceptions of the given school within which they

work?

4: Given the hypothesised model proposed, do the relationships between

teachers’ attitudes towards inclusion, self-efficacy to deliver inclusive pedagogy,

and perceptions about whether and how inclusion was supported within their

school covary at a significant level?

In summary, the overall aim of this dissertation was to investigate the

inclusion of children with disabilities within PE classes in Ireland. As teachers

have been identified as one of the most important enablers of inclusion, this thesis

aimed to explore Irish PE teachers’ attitudes and self-efficacy within the context

of their school. This thesis updates previous evidence and provides new

information that can be used to (i) implement future interventional studies; (ii)

inform policy and stakeholders through research-driven evidence; and (iii) prompt

schools and PE teachers to generate more awareness regarding the inclusive

practices within the Irish schools.

13

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23

Chapter 2: Inclusion of children with special educational needs

and disabilities in physical education: A systematic review and

meta-analysis of teachers’ attitudes.

This chapter is presented as the author-accepted manuscript of a peer-reviewed

articles published in the Educational Research Review Journal (2022; 35,

100456)

2.1 Abstract

Research shows that teachers’ attitudes toward physical education are

associated with positive pupil outcomes. However, there is limited robust

synthesis of evidence regarding teachers’ attitudes toward working with

vulnerable learners in physical education, particularly those with special

educational needs and disabilities (SEND). This mixed methods systematic

review and meta-analysis synthesizes the research evidence on teachers’

attitudes towards the inclusion of children SEND children in physical education.

Results indicated that teachers have largely favourable attitudes toward the

inclusion of children with SEND in physical education, and that experience

working with children with SEND was positively associated with such favourable

attitudes. Further quantitative and qualitative synthesis also revealed that several

different factors affect teachers’ attitudes – namely, knowledge and preparation,

years of teaching experience, direct experience working with SEND children,

type, and degree of SEND, and collaboration and teaching support.

Keywords: physical education, inclusion, teachers’ attitudes, children with

disabilities, special educational needs

24

2.2 Introduction

There is widespread consensus that physical activity is beneficial for child

development, including socialization and health (Janssen and LeBlanc, 2010),

and international organizations now strongly advocate for engagement in regular

physical activity as universally beneficial for all children regardless of ability status

(World Health Organization, 2020). Despite the increased research emphasis on

physical activity and its health- and development-related benefits for people and

youth with disabilities (Kapsal et al., 2019; Hassan et al., 2019), young children

and adolescents with special educational needs and disabilities (SEND) remain

disproportionally negatively affected by health conditions relating to physical

inactivity and sedentary time (Rimmer and Rowland, 2008; Collins and Staples,

2017, Pan et al., 2015). Of particular note within the existing research base is the

extent to which SEND children remain excluded from structured physical

education classes within schools (Maher, Williams, Olds, and Lane, 2007) or do

not fully engage in PE activities (Sit et al., 2017), despite studies showing that

SEND children often enjoy being physically active (Coates and Vickerman, 2010;

Leo and Mourton, 2020; Rekaa, Hanisch, and Ytterhus, 2019). This evidence is

particularly problematic since high-quality physical education has been

highlighted as an important strategic area for both the promotion and facilitation

of physically active lifestyles in childhood and adolescence (Murphy and

Carbone, 2008).

Since the early 2000s, multiple studies have focused on synthesizing the

research evidence on teachers’ attitudes toward the inclusion of children with

SEND in physical education (Block and Obrusnikova, 2007; Hutzler, Meier,

Reuker, and Zitomer, 2019; Qi and Ha, 2012; Rekaa et al., 2019; Tant and

Watelain, 2016; Wilhelmsen and Sørensen, 2017). As constructs that represent

a person’s (un)favorableness towards an object, action, or event (Doulkeridou et

al., 2011), attitudes have been widely regarded by researchers as ‘presage’

factors (O’Brien, Kudláček, and Howe, 2009, p. 47) that signal the behavioural

intentions of teachers vis-à-vis the inclusion of SEND children in physical

education. As such, research on inclusive physical education has been linked

primarily to Ajzen’s (1991) theory of planned behaviour, within which an attitude

25

is defined as the psychological correlate of a person’s intention to perform a

certain behaviour. The original theory identified three components that converge

to determine such an intention: (i) attitudes, which refer to the personal evaluation

of the behaviour in question; (ii) subjective norms, which refers to perceptions of

social pressures bearing on the behaviour in question; and (iii) perceived

behavioural control, which refers to the factors that facilitate or inhibit the

behaviour in question (Ajzen, 1991). In short, the theory of planned behaviour

provided fertile ground with which to develop research on inclusion in physical

education because teachers’ attitudes were deemed to be the principal link

between social pressures for greater inclusion and classroom-level behavioural

change in schools.

Existing reviews of the evidence on inclusion in physical education reveal

mixed outcomes (Wilhelmsen and Sørensen, 2017). For example, early reviews

(Block and Obrusnikova, 2007) reaffirmed the ‘disappointing, yet not surprising,

finding’ (ibid., p. 116) that teachers often have unfavourable attitudes towards the

inclusion of SEND children. Later reviews signal something of a step-change from

overtly unfavourable attitudes towards feelings of apprehension about working

with SEND children (O’Brien et al., 2009), concerns about the adequacy of

professional preparation and opportunities for collaboration (Tant and Watelain,

2016), and a general recognition that multiple factors and stakeholders can affect

teachers’ attitudes towards inclusion in physical education (Qi and Ha, 2012;

Wilhelmsen and Sørensen, 2017). In the most-recently-published systematic

review, Rekaa et al. (2019) concluded that, despite discrepancies between

studies over time – and, crucially, despite some discrepancies between ‘inclusive

norms [yet to be] realized as inclusive practices’ (p. 52) – at a macro level,

‘change is taking place’ (ibid., p. 53).

2.3 Aims

Despite the publication of these key studies, the research base still lacks

robust synthesis. In particular, despite many strengths, previous attempts to

systematically review the literature have largely focused on synthesizing

qualitative research evidence in a discursive manner (Rekaa et al., 2019). And,

26

where quantitative research has been addressed, it has mostly been reviewed in

the form of a ‘descriptive synthesis’ (Wilhelmsen and Sørensen, 2017, p. 329) as

opposed to being robustly meta-analysed. Despite many published studies

spanning numerous decades, the field is therefore still limited regarding what can

be said about the strength of the evidence for (or indeed the relative weighting of

factors affecting) teachers’ attitudes towards inclusion. Against this backdrop, this

paper presents the first mixed method systematic review and meta-analysis of

the research evidence on teachers’ attitudes towards the inclusion of SEND

children in physical education. Two key objectives frame the following analysis:

firstly, to assess and thereafter quantitatively estimate the extent to which

teachers held mostly favourable or unfavourable attitudes towards the inclusion

of SEND children in physical education; and, secondly, to identify the range of

personal, professional, social, and practical factors that can potentially affect

attitudinal formation.

2.4 Method

This mixed methods systematic review was conducted following the

Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines

(Liberati et al., 2009). Both qualitative and quantitative studies were included in

the review, and the process for selecting, searching, and synthesis is described

in the following subsections.

2.4.1 Inclusion and Exclusion Criteria

The target population was in-service primary and secondary school

physical education teachers. Studies were included if they were published: (1) in

peer reviewed journals; (2) in English; and (3) between the 1st of January 19751

and the 31st of December 2018. Studies were excluded from consideration if: the

target population were either pre-service physical education teachers or support

teachers (e.g., Learning Support Assistants); or the setting was early years

childcare, preschool, kindergarten, or at a university.

27

2.4.2 Databases and Search Strategy

A search of eight electronic databases was conducted between

September 2018 and March 2019 to identify the relevant studies in the systematic

review. The final search was conducted in March 2019, the databases, and

precise key terms for which are available in Appendix 1. The studies yielded by

the search strategy were imported into RAYYAN (Ouzzani, Hammady,

Fedorowicz, and Elmagarmid, 2016). After removing duplicates, two authors

independently screened the title and the abstract of each study against the

inclusion/exclusion criteria. Differences in the authors’ lists of included studies

were resolved via consensus. In the final step of the search strategy, the

reference lists of the included studies were checked to ensure saturation.

2.4.3 Risk of bias

Study quality was independently evaluated by two authors. Qualitative

studies were assessed using the Critical Appraisal Skills Programme Qualitative

Checklist (CASP, 2019). Quantitative studies were assessed using a checklist for

studies using a questionnaire (Boynton and Greenhalgh, 2004). The criteria for

both checklists were either coded as yes (✓) if they were explicitly presented and

described, no (✗) if they were absent, or unclear (?) if they were not defined.

Differences in the risk of bias assessment were resolved via consensus. The

outcomes of the risk of bias assessments are summarized in Tables 2.1 and 2.2.

28

Table 2.1. Risk of Bias Assessment for the Qualitative Studies.

Authors, Year

Valid results

Qualitative

methodology

Research

design

Recruitment

strategy

Data

collected

Relationship

researcher &

participant

Ethical

issues

Data

analysis

Clear

findings

Overall

quality

Ammah & Hodge 2006

✓

✗

✓

H

Casebolt & Hodge 2010

✓

✗

✓

H

Combs et al. 2010

✓

✗

✓

H

Elliott 2008

✓

?

✓

✗

✓

M

Hardin 2005

✓

✗

✓

H

Hersman & Hodge 2010

✓

✗

✓

H

Hodge et al. 2004

✓

✗

✓

H

Hodge et al. 2009

✓

✗

✓

H

LaMaster et al. 1998

?

✓

✗

✓

M

Lienert et al. 2012

✓

✗

✓

H

Morley et al. 2005

✓

✗

✓

H

Qi et al. 2017

✓

✗

✓

H

29

Sato & Hodge 2009

✓

✗

✓

H

Sato et al. 2007

✓

✗

✓

H

Tanure Alves et al. 2017

✓

✗

✓

H

Townsend 2017

✓

✗

✓

?

✓

H

Vickerman & Coates

2009

✓

✗

✓

H

Zitomer 2016

✓

✗

✓

H

H = High, M = Moderate, L = Low. ✓ = Explicitly present, ✗ = Absent, ? = Unclear.

30

Table 2.2. Risk of Bias Assessment for the Quantitative Studies.

Authors, Year

Validated

questionnaire

Example

question

Adequate

sample

Adequate

demographic

data

Distribution &

administration

Adequate

response

rate

Appropriate

analysis

Relevant

data

Link

between

data &

conclusion

Overall

quality

Arab & Lytle 2002

✓

✗

✓

H

Beamer & Yun 2014

✓

✗

✓

H

Block & Rizzo 1995

✓

✗

✓

H

Dordic et al. 2014

✓

✗

?

✗

✓

M

Doulkeridou et al. 2010

✓

✗

?

✓

✗

M

Doulkeridou et al. 2011

✓

?

✓

H

Fornidou et al. 2001

✓

?

✓

H

Heikinaro & Sherrill 1994

✓

✗

✓

✗

✓

✗

✓

M

Hersman & Hodge 2010

✓

✗

✓

✗

✓

M

Hodge et al. 2009

✓

✗

✓

✗

✓

M

Hutzler & Barak 2017

✗

✓

✗

✓

✗

✓

M

31

Jarvis Chaput & French 1990

✗

✓

?

✓

✗

✓

L

Jeong & Block 2011

✓

H

Jerlinder et al. 2010

✗

✓

✗

✓

✗

✓

M

Li et al. 2012

✓

✗

✓

H

Maeda et al. 1997

✓

✗

✓

M

Mauerberg-DeCastro et al.

2013

✗

✓

✗

?

✓

M

Meegan & McPhail 2006

✗

✓

?

✗

✓

✗

✓

M

Obrusnikova 2008

✓

✗

✓

H

Ogu et al. 2017

✓

✗

?

✓

M

Ozer et al. 2013

✓

✗

✓

✗

✓

M

Papadopoulou et al. 2004

✓

✗

✓

?

✓

H

Rizzo 1985

✗

✓

✗

✓

M

Rizzo & Wright 1987

✓

✗

✓

H

Rizzo & Vispoel 1991

✓

✗

✓

H

Rizzo 1984

✓

✗

✓

H

32

Sideridis & Chandler 1996

✗

✓

✗

?

✗

✓

L

Wang et al.2005

✓

H

H = High, M = Moderate, L = Low. ✓ = Explicitly present, ✗ = Absent, ? = Unclear.

33

2.4.4 Data Extraction, Synthesis, and Analysis

Quantitative data were synthesized in two ways. First, data that were

collected using the same validated measures were meta-analysed to estimate

the extent to which teachers hold favourable, neutral, or unfavourable attitudes

towards the inclusion of SEND children in physical education. See section 3.5 for

a description of how the meta-analyses were conducted. The remaining data from

quantitative studies were extracted and translated into standardized effect sizes

(e.g., Cohen’s d for evaluating mean differences between groups) by the authors

to facilitate a robust narrative synthesis and interpretation.

Qualitative data were synthesized into themes using the following process:

two authors independently (i) read the qualitative studies; (ii) identified the

themes that were initially generated within each study by the original authors; (iii)

categorized these within-study themes into higher-order themes based on

whether or not they had been reported across multiples studies; (iv) resolved

discrepancies in the two lists of higher-order cross-study themes through

consensus. Data from studies that reported these higher-order themes were

subsequentially narratively synthesized.

2.4.5 Meta-Analysis of Cross-Sectional Studies

Following Hopkins’s (2018) suggestion to standardize data before use in

a meta-analysis, data extracted from studies using validated attitudinal

questionnaires were rescaled to a minimum and maximum possible value of 0

and 100, respectively. Once rescaled, data from individual studies were centred

on a mean of zero. This facilitated an estimate (against the null) of the extent to

which studies showed favourable or unfavourable attitudes towards the inclusion

of children with SEND. This centring also had the added benefit of facilitating the

production of a forest plot against which we could assess study attitudes against

a neutral value of 0.

The Hartung-Knapp-Sidik-Jonkman method for estimating continuous

random effects was used to meta-analyse these data (Inthout, Ioannidis, & Borm,

2014). The extent of between-study variability was calculated as a standard

deviation (Tau). Uncertainty in the meta-analysed effect is presented as a 95%

34

confidence interval (CI). The meta-analysed mean was evaluated using the

following scale of magnitudes: <10, trivial; 10-30, small; 30-50, moderate; 50-70,

large; >70, very large (Hopkins et al., 2009). This scale was halved for evaluating

the between-study standard deviation, or Tau (Hopkins, 2015). Data were meta-

analysed in R Studio using the metagen package (Harrer, Cuijpers, Furukawa,

and Ebert, 2019).

2.5 Results

The search strategy yielded 1,385 studies, of which 448 were excluded

because they did not meet the inclusion criteria. Of the 937 remaining articles,

291 duplicates were removed. After title and abstract screening, a further 610

articles were excluded, and a total of 36 articles were deemed eligible for the

systematic review. One author (anonymized) screened the references of

previously published systematic reviews and found eight additional articles that

were eligible for inclusion. Therefore, the total number of articles included in this

study was 44 (Fig. 2.1). In total, 28 studies reported quantitative data gathered

using either a questionnaire or a survey. Eighteen studies reported qualitative

data obtained via either interviews or open-ended questioning. A further two

mixed-methods studies were included both in the qualitative and quantitative

syntheses.

35

Figure 2.1: Flow diagram of the studies included in the systematic review.

36

2.5.1 Quantitative Studies

Twenty-six of the 28 studies reported quantitative data from a cross-

sectional design (Table 2.3). Two studies reported the outcomes of a controlled

trial of interventions affecting teachers’ attitudes. As such, the baseline

assessments served as cross-sectional data. Twelve studies were conducted in

the USA, three in Greece, and one each in Nigeria, Serbia, Cyprus, Finland,

Israel, Canada, Korea, Sweden, Hong Kong, Brazil, Ireland, Turkey, and China.

Twenty-five articles used a validated questionnaire. Three studies used a

bespoke survey.

As for the population of interest, nine studies investigated both primary

and secondary school teachers, five studies investigated primary school teachers

only, seven studies surveyed secondary school physical education teachers, and

seven studies did not report any descriptive data that enabled us to assess the

type of school or school level being investigated. Fourteen studies used a sample

greater than or equal to 100, thirteen used a sample smaller than 100, and one

study did not report the sample size (and it was subsequently excluded from the

meta-analysis). Two articles with a sample size of five and 29 participants

respectively used both a validated questionnaire and face-to-face focused

interviews to collect data regarding teachers’ attitudes.

37

Table 2.3. Studies Included in the Quantitative Synthesis.

Study

Country

Design

Sample characteristics

Questionnaire used

Size

mean Age

(SD)

Women

Men

Arab & Lyttle 2002

USA

Cross-

sectional

60

N/A

30

Physical Educators' Attitudes toward

Teaching Individuals with Disabilities-III

Beamer & Yun 2014

USA

Cross-

sectional

142

46.0(9.2)

90(63%)

52(37%)

Teachers' Beliefs and Intentions toward

Teaching Students with Disabilities

Block & Rizzo 1995

USA

Cross-

sectional

91

39.0(9.1)

57

34

Physical Educators' Attitudes toward

Teaching Individuals with Disabilities-III

Dorđic et al. 2014

Serbia

Cross-

sectional

84

N/A

80

4

Attitude Toward Inclusive Physical

Education

Doulkeridou et al. 2010

Greece

Cross-

sectional

155

37.7()

85

70

Attitudes toward Inclusion of Children

with Physical Disabilities in Physical

Education - for Greece

Doulkeridou et al. 2011

Greece

Cross-

sectional

410

33.6(5.9)

210

200

Attitudes toward Inclusion of Children

with Physical Disabilities in Physical

Education - for Greece

Fournidou et al. 2011

Cyprus

Cross-

sectional

100

47.2()

47

53

Attitudes toward Inclusion of Children

with Physical Disabilities in Physical

Education - for Greece

Heikinaro-Johansson & Sherrill

1994

Finland

Cross-

sectional

307

39.2()

161

146

Teacher Beliefs About Physical

Education Integration Scale

38

Hersman & Hodge 20101

USA

Cross-

sectional

5

40.0(4.3)

3

2

Physical Educators' Judgments About

Inclusion

Hodge et al. 20091

USA

Cross-

sectional

29

41.0(9.8)

11

18

Physical Educators' Judgments About

Inclusion

Hutzler & Barak 2017

Israel

Cross-

sectional

121

41.0(9.3)

75

46

N/A

Jarvis & French 1990

Canada

RCT

14/14

N/A

Learning Handicapped Integration

Inventory

Jeong & Block 2011

Korea

Cross-

sectional

220

37.1(7.5)

42(19%)

178(81%)

Teachers' Beliefs and Intentions toward

Teaching Students with Disabilities

Jerlinder et al. 2010

Sweden

Cross-

sectional

221

35.5()

106(48%)

115(52%)

N/A

Li et al. 2012

Hong Kong

Cross-

sectional

83

N/A

31

52

Integrated Physical Education Service

Delivery Questionnaire

Maeda et al. 1997

USA

Cross-

sectional

26

N/A

15

11

Physical Educators' Perceptions of

Inclusion Inventory

Mauerberg-DeCastro et al. 2013

Brazil

Non-RCT

47/28

38.4(8.2)

70

5

N/A

Meegan & MacPhail 2006

Ireland

Cross-

sectional

N/A

Physical Educators' Attitudes toward

Teaching Individuals with Disabilities-III

Obrusnikova 2008

USA

Cross-

sectional

168

44.0(10.0)

89

79

Physical Educators' Attitudes toward

Teaching Individuals with Disabilities-III

Ogu et al. 2017

Nigeria

Cross-

sectional

66

N/A

33

Physical Educators Attitude Toward the

Teaching of Handicapped

39

Ozer et al. 2013

Turkey

Cross-

sectional

729

N/A

214

515

Teachers' Attitude toward Children with

Intellectual Disability Scale

Papadopoulou et al. 2004

Greece

Cross-

sectional

93

37.0()

37

56

Teacher Integration Attitudes

Questionnaire

Rizzo 1984

USA

Cross-

sectional

210

N/A

Physical Educators Attitude Toward the

Teaching of Handicapped

Rizzo 1985

USA

Cross-

sectional

194

40.0(8.2)

74

120

N/A

Rizzo & Vispoel 1991

USA

Cross-

sectional

94

38.0(7.4)

46

48

Physical Educators Attitude Toward the

Teaching of Handicapped-II

Rizzo & Wright 1987

USA

Cross-

sectional

136

N/A

59

77

Physical Educators Attitude Toward the

Teaching of Handicapped

Sideridis & Chandler 1996

USA

Cross-

sectional

56

36.0()

N/A

Teacher Integration Attitudes

Questionnaire

Wang et al. 2015

China

Cross-

sectional

195

33.0(6.7)

71

124

Physical Educators' Attitudes toward

Teaching Individuals with Disabilities-III

1. Hersman & Hodge 2010 and Hodge et al. 2009 were included both in quantitative and qualitative syntheses. RCT: Randomized Controlled Trial.

40

Meta-Analyses

Of the 25 studies that used a validated questionnaire, 15 were eligible for

inclusion in the meta-analysis to assess the extent to which physical education

teachers hold favourable, unfavourable, or neutral attitudes towards the inclusion

of SEND children. Fig. 2.2 provides the descriptive statistics and weighted

standardized mean differences from zero for each of the individual studies (left).

These weighted mean differences and their respective 95% CIs are also plotted

on a forest plot (right) alongside the pooled meta-analytic mean (diamond). The

forest plot shows that the meta-analytic mean was positive (mean = 8.47) and

that the data were compatible with a trivial-to-small effect size (95%CI = 2.92 to

14.01). Heterogeneity in the data was small, but still substantial, as demonstrated

by the between-study standard deviation (Tau = 9.68).

Six studies were included in a meta-analysis to explore gender differences

in teachers’ attitudes. The forest plot (Fig. 2.3) shows that there was substantial

heterogeneity in the data. Males had more favourable attitudes in one study,

whereas females had more favourable attitudes in three. Perhaps unsurprisingly,

therefore, the meta-analytic mean difference in attitudes between the genders

was non-significant. Three studies were included in a meta-analysis to assess

the association between teachers’ attitudes and experience working with SEND

children. The forest plot (Fig. 2.4) shows that there was a small positive

association and also that there was limited heterogeneity in the association

between experience and teacher attitudes.

41

Figure 2.2: Meta-analysis of the weighted standardized mean differences across

studies. The vertical line represents the overall mean (zero). CI, confidence

interval.

Figure 2.3: Meta-analysis of the weighted standardized mean differences

between males and females. The vertical line represents no differences between

the compared groups. CI, confidence interval.

42

Figure 2.4: Meta-analysis of the weighted standardized mean differences

between teachers with and without direct experience working with SEND

children. The vertical line represents no differences between the compared

groups. CI, confidence interval.

43

Narrative Synthesis of Quantitative Studies

Six studies provided data showing that teachers’ attitudes towards the inclusion

of SEND children in physical education differed based on the type of SEND. The

standardized effect sizes from these studies are summarized in Table 2.4.

Table 2.4. Summary of the effect sizes reported in the studies that investigated

the association between teachers’ attitudes towards based on type of SEND.

Study

Results

Effect

sizea

CIs

p

value

Hutzler & Barack, 2017

More favourable toward children

independently mobile

0.90

0.40 to 1.50

<.001

Block & Rizzo, 1995

Less favourable toward children with

profound disabilities

-0.64

-0.91 to -0.37

<.001

Less favourable toward children with

more severe intellectual disabilities

0.52

0.24 to 0.80

<.001

Rizzo & Vispoel, 1991

Less favourable toward children with

behavioural disorders

0.64

0.36 to 0.92

<.001

Obrusnikova, 2008

Less favourable toward children with

emotional and behavioural disorders

-0.60

-0.86 to -0.34

<.001

Rizzo & Wright, 1987

More favourable towards children

with learning disabilities

0.22

0.09 to 0.35

<.001

Ogu et al, 2017

More favourable towards children

with learning disabilities

0.003

-0.08 to 0.9

.94

a Effects represent standardised mean differences in the teachers’ attitudes between groups (e.g.,

differences in teachers’ attitudes towards teaching children with and without a learning disability). The

magnitude of the effect sizes was evaluated according to the following (i.e., Cohen’s) scale: < 0.20,

trivial; 0.20 to < 0.50, small; 0.50 to < 1.00, moderate; > 1.00, large.

44

In terms of physical disabilities, Hutzler and Barak (2017) reported that

teachers had more favourable attitudes toward working with independently

mobile children – i.e., did not require assistive devices. Block and Rizzo (1995)

reported a moderate-sized difference in teachers’ attitudes based on the degree

of severity of SEND. Teachers were less favourable towards working with

children with profound disabilities. Rizzo and Vispoel (1991) found a difference in

teachers’ attitudes based on whether they were dealing with learning disabilities

or more severe intellectual disabilities and behavioural disorders. Later research

by Obrusnikova (2008) also reported that teachers had less favourable attitudes

towards working with children with emotional and behavioural disorders than with

other types of SEND (i.e., physical, intellectual, sensory, and learning

disabilities).

Two studies (Ogu, Umunnah, Nwosu, and Gloria, 2017; Rizzo and Wright,

1987) provided mixed results about teachers’ attitudes towards inclusion of

children with learning or physical disabilities. Rizzo and Wright (1987) found that

teachers had more favourable attitudes towards working with children with

learning disabilities, whereas a follow-up study by Ogu et al. (2017) found no

significant difference. A final two studies (Arab and Lytle, 2002; Meegan and

MacPhail, 2006) reported data that suggested differences in teachers’ attitudes

according to four different types of SEND. However, there was insufficient data

provided in these papers to calculate their corresponding standardized effects.

The remaining results that were extracted from the quantitative studies are

displayed in Table 2.5. Noteworthy is the extent to which engaging in professional

learning activities, such as undertaking inclusion-specific courses, was

associated with teachers’ attitudes toward inclusion. Three of four studies

reported large effect sizes (Hodge et al., 2009; Jerlinder, Danermark, and Gill,

2010; Maeda, Murata, and Hodge, 1997), suggesting that high-quality

professional development experiences could have a positive impact on teachers’

attitudes.

45

Table 2.5. Summary of the Quantitative Studies Results.

Theme

Study

Effect sizea

CIs

p value

Class size

Li et al., 2012

-0.20

-0.65 to 0.24

.38

Hodge et al., 2009

0.79

0.08 to 1.50

.030

Region (Urban

and Rural)

Dorđic et al., 2014

0.40

-0.02 to 0.82

.06

Teachers' age

Jerlinder et al., 2010

-0.28

-0.54 to -0.02

.035

Rizzo, 1985

-0.45

-0.9 to -0.002

.049

Heikinaro-Johansson &

Sherrill, 1994b

0.13

0.03 to 0.23

.009

Özer et al., 2013c

-0.06

-0.29 to 0.16

.29

Years' teaching

experience

Li et al., 2012d

0.46

-0.06 to 0.96

.084

Rizzo, 1985

-0.18

-0.23 to 0.10

.21

Beamer & Yun, 2014

0.16

-0.18 to 0.48

.34

Özer et al., 2013

0.37

0.16 to 0.70

.007

Professional

courses (CPD)

Hodge et al., 2009

0.57

-1.04 to 2.18

.43

Rizzo, 1985

0.28

-0.002 to .57

.06

Academic

courses

Hodge et al., 2009

0.64

-0.02 to 1.29

.06

Jerlinder et al., 2010

0.98

0.44 to 1.52

<.001

Maeda et al., 1997

0.90

-0.30 to 2.10

.14

Rizzo & Vispoel, 1991

0.22

-0.18 to 0.65

.30

a Effects represent standardised mean differences in attitudes between teachers with below (mean -1SD) and

above (mean +1SD) values on the predictors (e.g., differences in attitudes for teachers with below and above

average years of experience). The magnitude of the effect sizes was evaluated according to the following

(i.e., Cohen’s) scale: < 0.20, trivial; 0.20 to < 0.50, small; 0.50 to < 1.00, moderate; > 1.00, large.

b Attitudinal were estimated between pre-specified age categories: teachers aged between 22-31 and

teachers aged between 46-63.

c Attitudinal were estimated between pre-specified age categories: teachers aged between 21-30 and

teachers aged between 40-60.

d Attitudinal differences were estimated between teachers with fewer and more than six years of experience.

46

2.5.2 Qualitative Studies

Eighteen studies were included in the qualitative synthesis. Eleven studies

were conducted in the US, two in the UK and Japan, and one in Hong Kong,

Brazil, and Canada respectively. Each study used interviewing as the primary

research method: including open-ended questions, focused interviews, and semi-

structured interviews. In two studies (Ammah and Hodge, 2006; Hodge, Ammah,

Casebolt, Lamaster, and O’Sullivan, 2004), data were also collected using non-

participant observation. Seven studies investigated teachers’ ‘beliefs’ about

inclusion. Four studies investigated teachers’ ‘attitudes’ and ‘perceptions’ about

inclusion. Two studies investigated teachers’ ‘viewpoints’, and one study

investigated teachers’ explicit ‘concerns’ about including SEND children in their

classes. As for the populations of interest, five studies focused on primary school

teachers, eight studies focused on secondary school physical education

teachers, and four studies did not report data about the type of school within

which the teachers worked. Only one study investigated both primary and

secondary school teachers (Townsend, 2017).

A list of the themes that emerged from the qualitative synthesis is

presented alongside their corresponding studies in Table 2.6. Eight higher-order

cross-study themes were identified, the evidence for which is discussed in each

of the following subsections. It is noteworthy that four of these eight themes were

also reported in the sections above, in the quantitative synthesis. Therefore, we

have used a Venn Diagram (Fig. 2.5) to illustrate the factors associated with

teachers’ attitudes towards the inclusion of SEND children in physical education

for which we have quantitative and qualitative evidence (i.e., the union of the

Venn Diagram), and for which we have corroborating mixed-methods evidence

(i.e., the intersection). The following qualitative synthesis begins with a discussion

of the four factors located at the intersection, which might otherwise be regarded

as those factors for which we have the strongest empirical evidence – i.e.,

empirical evidence that was reported across multiple qualitative studies of

primary and secondary school teachers.

47

Figure 2.5: Venn Diagram of the themes emerged from the qualitative and the

quantitative syntheses.

!

Qualitative themes

Quantitative themes

Corroborated evidence

- Teaching assistance

- Peer and parental

support

- Use of inclusive

pedagogies

- Safety and environmental

consideration

- Teachers’ gender

- Region

- Teachers’ age

- Direct experience

working with SEND

- Knowledge

and preparation

- Type and degree

of disability

- Teachers’ previous

experience

- Class size

48

Table 2.6. Summary of the Themes Emerged from the Analysis of the Qualitative

Studies.

Theme

Studies in which the theme was reported

Knowledge and preparation

Ammah & Hodge 2006; Casebolt & Hodge 2010; Combs et al.

2010; Hersman & Hodge 2010; Hodge et al. 2004; Hodge et al.

2009; LaMaster et al. 1998; Lienert et al. 2001; Morley et al.

2005; Qi et al. 2017; Sato et al. 2007; Sato & Hodge 2009;

Tanure Alves et al. 2017; Townsend 2017; Vickerman & Coates

2009

Teachers' previous experience

Casebolt & Hodge 2010; Hardin 2005; Hersman & Hodge 2010;

Hodge et al. 2009; Morley et al. 2005; Sato et al. 2007; Sato &

Hodge 2009; Tanure Alves et al. 2017; Townsend 2017;

Vickerman & Coates 2009.

Type and degree of disability

Casebolt & Hodge 2010; Hersman & Hodge 2010; Hodge et al.

2004; Morley et al. 2005; Sato et al. 2007; Sato & Hodge 2009

Teacher collaboration and

teaching assistance

Ammah & Hodge 2006; Hersman & Hodge 2010; Hodge et al.

2004; Hodge et al. 2009; Lienert et al. 2001; Morley et al. 2005;

Qi et al. 2017; Sato et al. 2007; Sato & Hodge 2009; Tanure

Alves et al. 2017

Peer and parental support

Ammah & Hodge, 2006; Hodge et al., 2004; Hodge et al., 2009;

LaMaster et al., 1998; Lienert et al., 2001; Qi et al., 2017; Sato

et al., 2007; Zitomer, 2016

Class size

Ammah & Hodge, 2006; Hodge et al. 2004; Hodge et al. 2009;

Lienert et al., 2001; Qi et al., 2017; Sato et al. 2007; Sato &

Hodge 2009; Tanure Alves et al. 2017

Use of inclusive pedagogies

Ammah & Hodge, 2006; Combs et al., 2010; LaMaster et al.,

1998; Zitomer, 2016

Safety and environmental

considerations

Hodge et al., 2004; LaMaster et al., 1998; Qi et al., 2017; Sato

& Hodge, 2009; Vickerman & Coates, 2009;

49

Theme 1. Knowledge and Preparation

A prominent theme for both primary and secondary school teachers in the

qualitative synthesis was the background knowledge and the additional

preparations that teachers perceived as being necessary to work with children

with SEND. Lack of knowledge about different types of disabilities and

impairments was also reported by teachers as a particular concern. (Tanure

Alves et al., 2017). Teachers in 15 studies reported a lack of knowledge, which

they perceived as being due to shortfalls in pre-service training. The general

sense from physical education teachers being interviewed across studies was

that they did not have adequate preparation for inclusive physical education

during their initial teacher training (Ammah and Hodge, 2006; Vickerman and

Coates, 2009). Whilst this lack of preparation was a source of concern and

frustration, studies also showed that teachers were willing to be proactive and

seek out new knowledge to support their practice (Sato, Hodge, Murata, and

Maeda, 2007; Townsend, 2017).

Where academic preparation was perceived as inadequate, physical

education teachers reported that they needed to learn formally (e.g., attend CPD

workshops or conferences about inclusion) or informally (e.g., independently

research pedagogical strategies). Obtaining more knowledge about how to plan

for and support pupils with different types of disabilities was important (Hodge et

al., 2004; LaMaster, Gall, Kinchin, and Siedentop, 1998). Evidence suggests that

PE teachers value opportunities to learn about inclusive pedagogical strategies

and to obtain concrete examples of activities for use in their own classroom

(Hersman and Hodge, 2010; Qi, Wang, and Ha, 2017; Sato and Hodge, 2009) –

what some studies referred to as ‘coping strategies’ or ‘solutions’ (Lienert,

Sherrill, and Myers, 2001) to the challenge of inclusion.

Theme 2. Teachers’ Previous Experience

A second theme that emerged was the importance of teachers’ experience

working directly with SEND children. This theme was clearly evident amongst

secondary school teachers (five studies). This theme was also evident in a study

that combined the perspectives of both primary and secondary school teachers,

50

as well as in four studies that did not report the details of the study setting. Such

experience, teachers reported, was an essential aspect of developing their

working knowledge of inclusive practice, and, subsequently, building confidence

(Hardin, 2005). It was acknowledged that more years of experience teaching

SEND led to more favourable attitudes (Casebolt and Hodge, 2010; Hersman

and Hodge, 2010; Hodge et al., 2009; Morley, Bailey, Tan, and Cooke, 2005).

There was also evidence of a connection between teachers’ attitudes and the

degree to which teachers found working with SEND children satisfying or

rewarding. The evidence suggests that experience overcoming (perceived or

actual) barriers to working directly with SEND children (and subsequently seeing

them progress) can be a strong attitudinal reinforcer for teachers. In other words,

teachers’ experiences of working effectively with SEND children in physical

education built confidence and thereafter positively affected attitudinal judgments

(Sato and Hodge, 2009; Sato et al., 2007).

Theme 3. Type and Degree of Disability

The qualitative data corroborates the findings presented in section 4.1.2

about the association between the degree of disability and teachers’ attitudes –

however, for secondary school teachers only. Studies in the qualitative synthesis

also suggested that secondary school teachers were more favourable toward

working with mild and moderate as opposed to severe disabilities (Casebolt and

Hodge, 2010; Hersman and Hodge, 2010; Hodge et al., 2004; Morley et al., 2005;

Sato and Hodge, 2009; Sato et al., 2007). Teachers reported finding it especially

difficult to work with children with Emotional and Behavioural Disorders, such as

Attention Deficit and Hyperactivity Disorder or Autism Spectrum Disorder. They

reported feeling more competent working with ‘less disruptive’ disabilities

(Casebolt and Hodge, 2010; Hersman and Hodge, 2010; Hodge et al., 2004),

such as Learning Disabilities or Physical Disabilities (Morley et al., 2005). There

was a general sense across studies that teaching students with mild disabilities

was easier because it required fewer adaptations to lesson planning and

individual in-class activities. Children with mild disabilities were also perceived by

51

teachers as requiring less one-to-one time than students with severe disabilities

(Casebolt and Hodge, 2010; Morley et al., 2005; Sato and Hodge, 2009).

Theme 4. Class Size

Eight studies, of which five samples were collected across secondary

school teachers, and one from primary school teachers (samples were not

reported in two studies) reported that larger class sizes negatively influenced

teachers’ beliefs about the feasibility of including SEND children (Ammah and

Hodge, 2006; Hodge et al., 2009, 2004; Lienert et al., 2001; Qi et al., 2017; Sato

and Hodge, 2009; Sato et al., 2007; Tanure Alves et al., 2017). Teachers were

concerned about both the safety of lessons for SEND children, and also the

quality of teaching being delivered to support individual SEND learners. Teachers

were inclined to feel more confident and competent teaching SEND children in

smaller groups, where more individual attention could be given and where safety

concerns could be closely and directly monitored (Lienert et al., 2001; Qi et al.,

2017; Tanure Alves et al., 2017).

Theme 5. Teacher Collaboration and Teaching Assistance

Ten studies, of which 6 samples were from secondary school teachers and

one sample from both primary and secondary school teachers (samples not

reported in three studies) reported that the degree of support teachers perceived

they had influenced (either positively or negatively) their attitudes. In general, the

more support the teachers received, the more favourable their attitudes and

perceived efficacy (Hodge et al., 2004; Sato and Hodge, 2009). Supporting

behaviours between teachers were also widely reported. Teachers were keen to

share information and knowledge about effective inclusive practice with their

colleagues (Hersman and Hodge, 2010; Lienert et al., 2001; Qi et al., 2017).

Many studies show that collaboration helped teachers to ‘achieve’ greater

inclusion of SEND children (Qi et al., 2017; Sato et al., 2007).

Collegiality only goes so far, however. The following additional supports

were also perceived by teachers as necessary: requiring in-class teaching

assistants, buy-in from peers without disabilities during class time, and

52

collaboration with and reinforcing behaviours by parents outside of schools.

Practically speaking, the lack of availability of teaching assistants and

administrative support was raised as one of the major concerns. Clearly, there

was a perception that having SEND children in one’s class requires ‘more work’

(Ammah and Hodge, 2006; Hersman and Hodge, 2010; Hodge et al., 2009;

Morley et al., 2005; Qi et al., 2017; Sato et al., 2007). Particularly noteworthy was

the finding that teachers perceived physical education as receiving less support

in the form of teacher assistance than other school subjects (Morley et al., 2005),

even though it was widely acknowledged that having assistance during physical

education lessons was a major facilitator of inclusion (Morley et al., 2005; Tanure

Alves et al., 2017; Townsend, 2017).

Theme 6. Peer and Parental Support

Students without SEND were seen as a crucial factor impacting teachers’

attitudes about the degree of inclusion feasible within a given class. This theme

was reported across samples of primary and secondary school teachers. The

acceptance of and expression of prosocial behaviours toward SEND children

were seen as direct enablers of inclusion (Ammah and Hodge, 2006). In fact,

helping behaviours from children without SEND were perceived as a useful

teaching strategy in themselves (Hodge et al., 2004; LaMaster et al., 1998;

Zitomer, 2016). The opposite was also the case, however. Unfavourable attitudes

amongst classmates – especially during competitive activities – raised concerns

among teachers and affected the degree to which inclusion could be achieved

within a given class session (Lienert et al., 2001; Qi et al., 2017).

Outside of the classroom, it was also clear from qualitative studies that

support from parents was an important factor affecting inclusion. Teachers

reported that collaborating with SEND children’s parents was a fundamental

aspect of inclusion (Qi et al., 2017; Sato et al., 2007). However, this was not

always achievable. For example, qualitative studies show that parents often have

very different views about inclusive practices (Hodge et al., 2009). Some parents

simply do not want their child to be in class with children without SEND (Qi et al.,

2017). Such a view, quite clearly, can directly affect a teacher’s attitude about

53

their role as a facilitator of inclusion, and about their responsibility to actively

promote and even prompt the inclusion of a given child in physical education

whilst at school.

Theme 7. Use of Inclusive Pedagogy

The importance of planning for and using an inclusive pedagogy was also

a recurring theme within qualitative studies, primarily from primary school

teachers (three from primary school teachers and one from secondary school

teachers). Combs et al. (2010), for example, found that teachers with favourable

attitudes were also teachers who developed written plans for their classes –

including considerations about how to differentiate one’s teaching strategy to

proactively enable inclusion. Thinking about modifications that would be required

in a lesson plan – and making sure that one had the necessary equipment to

support these modifications – were reported by teachers as strategies that were

necessary for including SEND children. Despite the commitment to and known

benefits of pursuing an inclusive pedagogy, teachers also reported challenges

making this a reality in the classroom. For example, teachers reported

experiencing difficulties managing their time properly when pursuing a more

inclusive pedagogy – i.e., managing the optimal balance of their time between

working with SEND children and working with the rest of the class (Ammah and

Hodge, 2006; LaMaster et al., 1998).

Theme 8. Safety and Environmental Considerations

A final theme that emerged across the qualitative literature was the need

for teachers, both from primary and secondary schools, to consider safety and

broader environmental factors affecting SEND children’s engagement in physical

education. For example, teachers found that it was easier to be inclusive during

indoor activities. This is because they had more control over the range of possible

environmental factors (e.g., easier to keep an eye on the group; access through

the changing rooms for wheelchairs) affecting SEND children. Regardless of

environmental conditions, however, teachers reported concerns about the

increased likelihood of injury for SEND children (Hodge et al., 2004; Qi et al.,

54

2017; Sato and Hodge, 2009). This was due not only to the nature of the activity

(Hodge et al., 2004; Sato and Hodge, 2009), but also to unexpected behaviours

of students with SEND, which were perceived by teachers as unduly risky, or not

worth the risk (Qi et al., 2017). Crucially, team-based activities were perceived as

being much more problematic for SEND children (Vickerman and Coates, 2009).

Data reported in Hodge et al. (Hodge et al., 2004), for example, showed clearly

that teachers were particularly fearful for SEND children during competitive team-

based activities, particularly as the tempo and the stakes of the game increased.

Such competitive contexts – namely, games and activities where ability levels are

clearly apparent and/or where there are clear winners and losers – raise the

question about the appropriateness of certain activities for SEND children. In

such contexts, Sato and Hodge (2009) acknowledge that there are often clear

physical risks to SEND children. However, far from simply being a matter of

physical risk, the qualitative evidence also suggests that psychological, or

psychosocial, risks can arise when activities are inappropriately designed. Sato

and Hodge (2009) interviewed teachers who were concerned about the

‘psychological safety’ (ibid., p. 166) of SEND children and the risk of students

feeling a sense of inferiority or alienation from the norms of their peer group. In

the worst-case scenario even reported having a fear of SEND children

experiencing verbal and physical abuse from their peers if the entire class was

not constantly supervised (LaMaster et al., 1998).

2.6 Discussion

2.6.1 Reflections on the Evidence

The purpose of this mixed-methods systematic review and meta-analysis

was to evaluate the available research evidence on teachers’ attitudes toward the

inclusion of children with SEND in physical education classes. The results

indicated that teachers’ attitudes were positive overall, with only a small degree

of between-study heterogeneity. In contrast with some findings from previously

published reviews in the domain of general education (Scruggs and Mastropieri,

1996; Avramidis and Norwich, 2002; de Boer, Pijl and Minnaert, 2010; cf. Russell,

55

Scrinney and Smyth, 2022), this is both a significant and promising new finding.

The finding is significant because teachers’ attitudes are consistently reported in

the research evidence as key proximal factors affecting the inclusion of students