Individuals with disabilities are an under-served and at-risk population. With regard to health outcomes, individuals with disabilities experience risk of developing heart disease and diabetes at two to three times the rate of those without disabilities.1 Physical activity (PA) reduces the likelihood of experiencing cardiovascular disease and diabetes among children2; however, children with disabilities are less active than their peers without disabilities,3 and face limitations for PA engagement due to lack of accessibility, knowledge, and appropriate equipment.4 These structural and environmental barriers detract from well-being by hindering children with disabilities from building healthy habits of movement5 – habits which carry into adolescence and adulthood.6,7

Play, or the ability to interact with others freely and under one's own control, is a primary source of PA and a childhood right, according to the United Nations Rights for the Child.8 Children's participation in PA through play establishes positive, inclusive experiences between peers, contributing to physical, social, and emotional health.9 While schools exist as pillars for community engagement and offer many opportunities for active play and inclusive peer engagement, children with disabilities are often limited by the inaccessibility of the playgrounds and play fields.3 Accessibility and inclusivity are often used synonymously; however, these terms carry different connotations with important implications for the social and physical environment of the playground.10 The Centers for Disease Control and Prevention (CDC) defines accessibility within the construction of a space to ensure ease and safety for an individual with disabilities to navigate.11 Inclusivity means that individuals with disabilities are met with nondiscriminatory treatment and that individuals are included as much as possible in any setting.11 Because inclusive playgrounds rely upon children with and without disabilities engaging together in meaningful play,12 accessibility of the playground is an important precursor for fully inclusive PA opportunities. The World Health Organization (WHO) identifies the provision of opportunities for play as critical elements to the International Classification of Functioning, Disability and Health (ICF).13 Identifying the accessibility of play spaces is important as these settings are environmental determinants of health and quality of life among children with disabilities.13

Perceptions of playground accessibility for children with disabilities are generally poor. For example, in a study with special education teachers and their perceptions of community and school playground accessibility, most felt children with disabilities had less access to playground equipment structures than children without disabilities.14 While guidance on the development and structure of playgrounds exists, research assessing the current state of playground accessibility is limited, particularly in school settings within the United States.12

To better meet the needs of children with disabilities, the Americans with Disabilities Act (ADA) updated its Standards for Accessible Design in 2010 to include more structured guidance for designing playground facilities. Specifically, any playground modified or built after March 2012 should comply with the updated standards which support better access to playground structures for children using mobility devices.15 While these standards create a foundation for children with disabilities to participate among their non-disabled peers, they do not apply to the many school and community playgrounds already in use. Further, the interpretation of these laws and guidelines are not uniform nor are they necessarily best practices for children with disabilities.10 As a result of these circumstances, accessible opportunities for play and social engagement throughout the day are likely to vary across schools and states. Of the 70,291 public pre-kindergarten, elementary, and middle schools operating in Arizona communities since the 2011–2012 school year,16 the number of schools with renovated playgrounds is unknown, and the majority were built before the ADA guidelines were placed into effect. At the national level in 1998, approximately 28% of public schools were built before 1950, and 45% were constructed between 1950 and 1969.17 While many of these may have had some renovations since their construction, it is likely that these renovations have also occurred before the Standards for Accessible design were set in place.

The presence of accessible playgrounds in schools heavily impacts the level of PA for young children within the larger community setting.18 Examining the current status of elementary school playground accessibility in Arizona is important to obtain a comprehensive understanding of how built environmental factors in schools can maximize opportunities for PA among children with disabilities. This study was guided by the Fundamental Cause Theory which supports the consideration of social conditions and factors (such as socioeconomic status and family or community support),19 and framed under the social-ecological perspective which emphasizes the impact of the social and physical environments on individual behavior.20 The purpose of this study was to examine teachers’ perceptions of accessibility by assessing perceived adequacy of play spaces in high- and low-income elementary school settings, including play fields, playgrounds, and gymnasiums, for students with and without disabilities in Arizona.