Participation in out-of-home activities and health-related quality of life among Australian children with disabilities: Evidence from the longitudinal study of Australian children.

BACKGROUND: Participation in out-of-home activities (OoHA) is hypothesised to enhance the physical, emotional, and social development of children with disabilities, as well as their health-related quality of life (HRQoL). However, longitudinal evidence in the Australian context remains limited. OBJECTIVE: To examine the relationship between OoHA participation and HRQoL among children with disabilities using a population-based longitudinal dataset. METHODS: Data were drawn from eight waves (2004-2018) of the Longitudinal Study of Australian Children, comprising 2480 unique children with disabilities (3694 children-wave observations). HRQoL was measured using the Paediatric Quality of Life Inventory instrument. OoHA was defined as participation in community activities, including movie or sporting events, playgrounds or swimming pools, concert or museum visits, visiting libraries, or religious services. Panel regression (random-effects) model was employed, controlling for child and family-level covariates. RESULTS: OoHA participation was significantly associated with higher overall HRQoL (β=3.43, 95% CI: [1.27, 5.59], p = 0.002). More specifically, significant positive associations were observed for the physical (β=4.52, 95% CI: [1.81, 7.23], p = 0.001), social (β=4.12, 95% CI: [1.05, 7.19], p = 0.009), and school (β=4.03, 95% CI: [0.92, 7.13], p = 0.011) domains. A graded association was evident, with overall HRQoL scores increasing from 1 activity (β=3.12, 95% CI: [0.77, 5.46], p = 0.009) to 2-3 activities (β=3.34, 95% CI: [1.15, 5.54], p = 0.003) and to 4-5 activities (β=4.41, 95% CI: [2.06, 6.76], p < 0.001). CONCLUSIONS: Diverse OoHA participation was associated with higher HRQoL among children with disabilities. Targeted funding should expand equitable access to inclusive programs across all regions and socioeconomic groups, supported by formal partnerships among schools, local governments, and disability service providers.