Participants’ experiences of the intervention
At the individual or intrapersonal level
Physical and psychological health. Reduction of lumbar spine pain and improvements in body coordination were the positive outcomes perceived by the participants.
One of the male participants (M4) stated that SLVB helped to reduce lumbar spine pain: “I often sat on the floor while playing SLVB. Eventually, I found that my lumbar spine and hip bones had become more flexible than before. I used to have lumbar spine pain. After playing SLVB, I found it less painful than before.”
Two male participants, (M6) and (M2), stated that SLVB was good for physical coordination: “We have to rotate and manage hand–eye coordination … Hand–eye coordination is important for catching a ball” and “It demands reactivity [reaction]and synchronization of the players … As such, I think it is good for the growth of the brain and body.”
In addition to physical health, potential improvements in psychological health (positive mood and reduce anxiety) and quality of sleep were mentioned by some participants.
A female participant (F5) reported “Playing SLVB puts me in a good mood. I become worry-free when I’m focused on the ball.”
Enjoyment. Analysis of the semi-structured interviews indicated participants’ perceived enjoyment when playing SLVB.
One male participant (M3) stated “The sport ground was full of happiness and laughter. People cheered when someone had a good serve. They laughed when someone hit the ball out of bounds. The atmosphere was joyous. (How about you?) I felt happy too.”
Novelty. Because SLVB was new to the participants, they were curious and eager to learn what it was, how it was played, and whether they could participate in this form of PA.
One female participant (F1) stated “SLVB was new to me. The moment I first heard of SLVB, I wondered if it can be played by wheelchair users like me. I was so curious to find out how it is played. Moving around the volleyball court, hitting a ball on my wheelchair, and so on are totally new to me. All this attracted me to the project.”
One of the male participants (M1) said “I wanted to know more about SLVB as a sport … I learned how to play a new kind of sport.”
Competence. The participants indicated that playing SLVB promoted a sense of competence derived not only from successful service, scoring points, and progressively mastering techniques but also from positive feedback from coaches.
One female participant (F4) said “I felt very happy when I served or received a ball well.” Another male participant (M4) stated, “If I hit a good ball, Sir Y.W. would praise .”
Autonomy. The participants stated that they had attained a gain in bodily autonomy and a sense of freedom from playing SLVB.
Bodily autonomy and sense of freedom were felt by a male participant (M6). He reflected: “After the caliper is removed, I can play it, rotate, and pick up the ball freely … Now, watching the videos, I found myself so free … I don’t need a wheelchair or caliper, which is so delightful. I also feel like I’m in a dream as if I am an astronaut, no limitations and no caliper.”
At the interpersonal level
Socialization and teamwork. In addition to making references to their physical and psychological health, the interviewees also described social interaction effects from participating in the SLVB intervention. Elements of teamwork such as mutual inclusion, cooperation, team spirit, and combined action as a group were described.
A male participant (M1) mentioned "The good things are ... interacting with my friends. With my teammates, we discussed how to win a game strategically and adapt ourselves to play better.”
A female participant (F2) said “Individual exercise differs from group exercise … Group exercise demands mutual inclusion, cooperation, and interaction among participants. For SLVB, you need at least 10 people to make it fun.”
Social support. Support from peers, friends, family members, coaches, and volunteers was evident during the intervention.
Support from peers, friends, and family was described by a female participant (F2) as follows: “Some of my classmates are very friendly. They are proactive and say “hello” to me and even invite me to play with them in a small group. They told me about some tricks for playing SLVB, which helped me do better.” A male participant (M2) stated “Most of them encouraged me to do so. My wife supported me too, even though she is more introverted than me.”
Support and positive feedback from coaches and volunteers were evident to a male participant (M4): “Sir Y.W. would praise me and say, ‘Well done, you have applied the skills I taught you.’ I got so much satisfaction from this positive feedback.” A female participant (F4) stated “I am very thankful to the ball boys and girls ... They helped by picking up the balls for us quickly. They did a great job.”
At organizational and community levels
Perceived sports venue environment. Venue comfort, privacy, spaciousness, and convenience positively affected engagement in the intervention.
One male participant (M4) exclaimed “Superb, superb! Unlike other play areas, there were no other players except us. I liked the privacy and comfort this facility gave me very much."
Accommodating numerous wheelchairs and participants’ belongings required sufficient space. One male participant (M6) commented on the venue: “The center is convenient and comfortable inside. It is big enough to store our wheelchairs and the air conditioning is great.”
Venue accessibility. Because many participants were wheelchair users and had walking impairments, accessibility concerns were a central part of discussions. The accessibility of a venue is vital to encouraging participation in a PA. One male participant (M3) said “Many of them had become proactive in playing SLVB, even though the venue was quite inconvenient for them to get to, given the steep road, insufficient parking spaces, and so on.”
Safety. Safety is a concern when playing sports, particularly for PWPI and people with relatively low fitness levels. When questioned regarding the potential risks of playing SLVB, a male participant (M3) stated “Every sport has its risks. SLVB players may strain their muscles. They may fall to the floor and get hurt if they don’t play it properly. At their ages, the chance of them hurting themselves is higher. It would be troublesome if they hurt their hands.”
Nevertheless, risk can be reduced by using proper techniques and protective gear, as mentioned by another male participant (M3): “Some people have a weak lumbar region. They will fall straight down onto the floor when they lose their balance. As you said before, they should have been taught how to fall properly so as not to hurt themselves, such as how to use elbow supports as buffers while falling.”
Dissemination of information. One female participant (F2) commented on the dissemination of information: “The enrolment process was smooth. However, I sometimes found that the dissemination of information was quite confusing ... It would be better if we could be informed as a group by a single party who has all our phone numbers.”
At the policy level
Resources allocated by the government. Concerns regarding the sustainability of activity sessions were raised by participants, who wanted to see local government departments provide resources to support activity sessions such as by providing community facilities to play SLVB. The lack of wheelchair-accessible facilities in the community discouraged participation in SLVB. One female participant (F1) stated “I rarely go out … for extra exercise … some places have staircases and are therefore not suitable for a wheelchair.”
She further commented “Many sports centers are booked for basketball and badminton, leaving no room for us to play SLVB. Alternatively, I think the government should let us book community halls to play SLVB. Community halls are big.” Supporting quotations are presented in Table 2. The model developed using the findings is presented in Fig. 1.
Fig. 1. Social Ecological Model Developed for the Study
Suitability and feasibility of SLVB intervention elements
Suitability. SLVB is played in the sitting position and involves movements with relatively low strain and intensity; hence, it was perceived to be suitable for PWPI.
A female participant (F3) stated “As you know, most HKFHY members are disabled in their legs. Exercises requiring a lot of leg movements don’t suit us. Because it is played in a sitting position, SLVB is suitable for us.”
Project content and coaching. In general, the project feasibility was perceived to be adequate, time-appropriate, and progressive, and the caring approach adopted by the coaches was appropriate and made instructions easy to understand.
One male participant (M2) said that the content of the project “was adequate. It takes time for you to progress from not knowing to knowing how to play ... The duration and progression of the project were good.” He (M2) added “I think that the two coaches started with the basics and then gradually taught us more techniques for playing SLVB (step by step approach). It should be OK.” Participant (M6) reflected that “It has a theoretical basis and is taught in a structured way. It is easily understood.”