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Abstract

Participatory and creative methods have gained traction in childhood disability research for eliciting children’s perspectives. However, little is known about how such approaches can be meaningfully adapted to online mode in low- and middle-income contexts (LMICs), where infrastructural, technological, and cultural barriers often restrict participation. Using a case example from Mumbai, where a study on school participation among children with physical disabilities was conducted, we illustrate how photo elicitation and mental map drawing were adapted for online use during the COVID-19 pandemic. Specifically, we demonstrate/discuss: (a) how the combination of such online approaches can be used effectively to support children’s participation in qualitative research; (b) how these approaches were adapted to an online environment in an LMIC setting; (c) possible limitations and challenges that are shaped by LMIC realities; and (d) analytic strategies. By amplifying methodological lessons from Mumbai, this paper contributes practical insights for researchers seeking to meaningfully involve children with disabilities in LMICs and other low-resource settings.

Keywords

participatory and creative approaches qualitative research children with physical disabilities online research low- and middle-income contexts

Introduction

The best practices for conducting qualitative research with children have evolved substantially over time. Historically, researchers have found it challenging to engage children in research, citing children’s limited research competence, difficulty in navigating power differences, balancing insider/outsider perspectives, and maximizing research participation (Bradbury-Jones & Taylor, 2015; Einarsdottir, 2007; Kim, 2012; Scott, 2008; Shen et al., 2017). The challenge is even more profound and multifaceted with children with disabilities (Bradbury-Jones & Taylor, 2015). For example, researchers highlight the practical issues that may arise when conducting studies, including data collection challenges such as gaining access, children’s limited attention spans (Lan et al., 2018), mobility restrictions (Moswela & Mukhopadhyay, 2011), motor impairments resulting in limited manual abilities (Schott et al., 2016), limited cognitive abilities (Loeb et al., 2018), difficulty in articulating thoughts and experiences (Healy et al., 2013), lack of understanding of the research process (Riggio & Reichard, 2002), and ethical challenges with obtaining consent/assent and protecting confidentiality (National Research Council, 2009). Despite these challenges, it has also been acknowledged that children with disabilities can participate in research as active social actors capable of expressing their own views about issues that concern them (Batorowicz et al., 2014).

Researchers have taken a reflexive, self-aware, and consultative approach to conducting research involving children (Graham et al., 2014; Huang et al., 2016). There has been increased attention to the ‘culture of consultation’, meaning that children are increasingly being supported to make their own decisions rather than having others make decisions on their behalf (Aitken & Millar, 2002; Komulainen, 2007). Best practices to actively involve children in research necessitate providing accessible formats for information and communication (Alquraini & Gut, 2012; Kyegombe et al., 2019), ensuring physical accessibility (Kyegombe et al., 2019), adapting traditional research methodologies (arts-based methods) to accommodate children’s specific needs (O’Neil, 2018), and adopting ethical considerations to protect children’s rights and well-being (Bell, 2008; WHO, 2017). This paper aims to share our experience of engaging a specific combination of participatory and creative online approaches to involve children with physical disabilities as participants in qualitative research in low- and middle-income contexts. Situating this work in Mumbai, India, we highlight the methodological significance of adopting such approaches within LMICs, where infrastructural barriers (Huus et al., 2021), unequal access to technology (Banaji et al., 2018), and cultural norms around children’s participation present distinct challenges (Duramy & Gal, 2020). These contextual constraints are rarely documented in the methodological literature, which largely reflects the experiences of high-income countries. By reflecting on the strategies and adaptations required in Mumbai, this paper contributes to advancing methodological guidance for researchers who seek to meaningfully engage children with disabilities in LMICs and other low-resource settings.

Children’s Voices in Qualitative Research

Although there has been a growing emphasis on including diverse perspectives in research, there is a lack of representation of children with disabilities’ voices. Specifically, children with physical disabilities have been underrepresented in research, and there is a need for practical and concrete guidelines to involve them as participants (Batorowicz et al., 2014, 2017; Benjamin-Thomas et al., 2019; Jolley et al., 2018; Njelesani et al., 2022; Pather, 2019). Involving children in research and eliciting their voices on matters concerning them is often presented as a trusted way to capture children’s lived experiences and offer them a sense of agency (Spencer et al., 2020). Komulainen (2007) described the voice as social and co-constructed, rather than individual, fixed, straightforward, linear, and clear. Multiple factors, including researchers’ self-assumptions about children, the particular use of language, and the institutional contexts in which we engage with children, constantly constrain and shape children’s voices. Further, Spyrou (2011) argued that a critical, reflexive approach to children’s voice research needs to consider the actual research context in which the children’s voices are produced and the power imbalances that shape them. It is noteworthy to highlight that children’s voices are often heavily impacted by the roles and actions of others.

Including children’s voices, particularly those with disabilities, in research supports their active participation and enables an understanding of their perspectives on important issues that affect their lives (Driessnack & Furukawa, 2011; Gibson, 2012). Researchers have explored the views and experiences of children and youth with disabilities in school settings using adaptive techniques, including observation and visual methods (i.e., drawing, photo-elicitation, body mapping) (Chung et al., 2019; Okyere et al., 2019; O'Leary & Moloney, 2020; Pincock & Jones, 2020; Spencer et al., 2020).

However, little consideration has been given to the use of a combination of participatory and creative approaches, along with online or digital tools, to carry out research with disabled children and young people. Multiple methods provide a pluralistic dataset that is instrumental in gaining insights into participants’ experiences, which may otherwise remain unknown, also making them active participants in the research process (Chamberlin et al., 2011; Okyere et al., 2021). Although online and creative methods, such as digital photo elicitation, photo voice, digital storytelling, online interviews, and discussion forums, are increasingly used in qualitative health research (Arias-Uruena & Vaghi, 2023; Borgstrom et al., 2019; Boucher, 2017; Rania et al., 2022), their use with disabled children and young people is not well established. Additionally, the existing body of literature lacks an exploration of how to utilize online platforms creatively to empower children with disabilities to participate with agency.

About the Study

This paper presents examples drawn from the first author’s doctoral thesis, which explored the participation and social interaction experiences of children with physical disabilities (hereinafter referred to as ‘children’) inside school settings in Mumbai, India. Further details of this study and the methods used are provided elsewhere (Gaurav et al., 2024). In a virtual study conducted in Mumbai, we explored children’s experience of participation and social interaction. We framed the study within an interpretative paradigm, as our aim was not to generalize but to explore the meaning of children’s experiences (Phothongsunan, 2010).

Methodological Adaptability

Methodological tools that are adaptable and interesting and create space within the research process for participation and freedom of expression are critical when eliciting the ‘voices’ of young people and expanding their capabilities (Pincock & Jones, 2020). This is especially important in lower- and middle-income countries where younger adolescents are often discouraged from expressing their voices (O'Leary & Moloney, 2020; Pincock & Jones, 2020). In many LMIC contexts, children’s expression is shaped not only by infrastructural and resource constraints but also by cultural and community norms that often discourage younger children from voicing their views (Pincock et al., 2024). In Mumbai, for example, children’s opportunity to express themselves was limited by hierarchical school environments, parental caution about speaking to outsiders, and broader social expectations that positioned children as passive recipients rather than active contributors. These barriers could have significantly constrained their participation in our study. To counteract this, we incorporated several deliberate adaptations: partnering with a local research assistant who was trusted in the community; scaffolding multiple creative methods (photographs and mental maps) to provide accessible entry points for expression; and using local culturally familiar terminology that resonated with children’s lived experiences. These strategies supported children in overcoming hesitation and validated their perspective as meaningful contributions, thereby countering the structural and cultural silencing often experienced in LMIC settings. Below, we describe the methodological adaptation in detail.

(a) Planned In-Person Methods

Initially, the study was designed to be conducted in person within school settings in the informal settlements of Mumbai. The initial plan was to use a combination of photo elicitation and mental map drawing methods in-person with children in their school settings (Gieseking, 2013; Zhang & Hennebry-Leung, 2023). Photo elicitation is a visual method in which the participants themselves generate photographs of settings or experiences that hold meaning for them, which are later used as prompts in interviews or discussions (Gibson et al., 2014). This approach typically offers children agency in selecting photos that best capture their perspectives, allowing them to anchor conversations in their lived realities. Photograph elicitation has been used previously in research with children with disabilities to explore their self-perception, lived experiences (McLaughlin & Coleman-Fountain, 2014), and perception of optimal activity settings (Gibson et al., 2014; King et al., 2014). Furthermore, Einarsdottir (2005) examined the utility of photo elicitation in understanding children’s perspectives on their experiences at playschool. Mental maps are visual and spatial qualitative methods in which participants draw representations of spaces that are meaningful to them, often illustrating relationships, activities, or experiences within those spaces (Gieseking, 2013). Typically conducted in person, children are asked to depict their environments (e.g., home, school, neighbourhood) and then explain their drawing, which provides researchers with insights into how they perceive their social and physical worlds.

Our plan was for children with physical disabilities to generate their own photographs of school activity settings (child-led- photo-elicitation) and co-construct mental maps with the researcher during the school visits. These activities were designed to be integrated into children’s daily school environments, enabling them to visually and spatially represent their participation and social interaction experiences in real-time. In-person sessions would have enabled direct observation, greater spontaneity in children’s responses, and richer contextual data through researcher immersion in the school environment.

(b) Methods Selected in the Context of the Pandemic

With the onset of COVID-19, schools were closed, physical access was restricted, and direct interaction with children was not feasible. To conduct the research ethically and safely, we selected a combination of researcher-generated photo-elicitation and child-led map drawing, both of which were conducted online. This selection was guided by two factors: (i) the need for methods that could be feasibly conducted within digital platforms while still engaging children meaningfully, and (ii) the need to preserve the participatory and creative orientation of the original design. Researcher-generated photographs of the school spaces provided contextual anchors for discussion, while mental maps allowed children to express their memories, emotions, and participation experiences creatively from home. These adaptations were necessary due to school closures and safety regulations.

(c) Adaptation to an Online Environment

The flexibility, reflexivity, and, importantly, the enjoyability of these methods may make children feel at ease, able, and willing to share their experiences (Brown et al., 2020). Adapting these methods to an online environment required several context-sensitive modifications. Researcher-generated photographs were shared on Zoom during online sessions, with prompts to elicit children’s recall and discussion of their experiences in familiar school spaces. Mental maps were facilitated by a local research assistant (RA) who provided children with drawing materials, explained tasks in culturally familiar terms, and supported children during the online session. Prompts were simplified and adapted to local language use (e.g., “gallery” instead of “corridor”, “jeena” instead of “stair”) to ensure clarity. Sessions were intentionally kept short and flexible to accommodate children’s attention spans and online fatigue. Opportunities were provided for continuation across multiple days if children preferred. These adaptations helped the participatory spirit of the study while responding to both pandemic restrictions and the broader challenges of conducting disability research in a low- and middle-income context, such as limited digital access, poor internet connectivity, and cultural hesitations around children’s self-expression. We have described these adaptations in detail later in the ‘Procedure’ section.

Before presenting details of our approach, we provide a brief overview of the study in which we implemented the above methods and strategies.

Synopsis of Research

The examples used in this study were drawn from one component of the first author’s doctoral thesis, which explored the design of inclusive school spaces in Mumbai. We employed Hammel et al. (2008)’s conceptualization of ‘meaningful participation’ as an active and meaningful engagement, having choice and control, access and opportunity, personal and societal responsibilities, impacting and supporting others, social connection, societal inclusion, and membership. We used the conceptualization of ‘social interaction’ by Sharma (1996), who described social interaction as establishing social contacts and communication with a classmate, peer, or an adult (teachers and staff) by doing activities together, participating in class, hanging out, and being together.

The thesis was divided into two studies. The first study (Gaurav et al., 2023) explored architects’ understanding of physical disability and how it translates to their school design in Mumbai, India. The second study (Gaurav et al., 2024) explored the participation experiences of children with physical disabilities in a community school in Mumbai to understand how schools might improve their meaningful participation and social interaction.

After receiving institutional approval from the University General Research Ethics Board (GREB) in Canada and local approval from concerned authorities in Mumbai, we sought informed verbal consent from parents and verbal assent from children. We sought children with diverse physical disabilities as described in the Gross Motor Function Classification System (GMFCS) (Palisano et al., 2007) and the Manual Ability Classification System (MACS) (Kuijper et al., 2010) to ensure broad representation and rich information (Flyvbjerg, 2006; Stake, 2006). It is noteworthy that despite efforts to include children with all levels of physical disabilities in the study, all participants mainly had difficulties with their gross motor functioning (mobility), and none of them had significant difficulties with their manual skills. Specifically, our participants had polio, paralysis, acquired disability, and one had cerebral palsy. They had difficulty walking, used crutches and sticks, and required physical support to move around. They could hold and use a pen and did not require adaptations for drawings (Table 1).

Table 1.

Participant Characteristics

Children (pseudonyms)	Age (in years)	Grade	Gender	Types of physical disability (obtained from school documentation)
Komal	9	5	Girl	Polio—causing atrophy in her ankle and drop foot, thus difficulty walking
Shadab	8	3	Girl	Cerebral palsy—deformities in the foot, thus difficulty walking
Zuber	10	5	Boy	Acquired physical disability—thus difficulty walking
Jyoti	15	7	Girl	Paralysis—difficulty walking and speaking, limited movement due to a paralyzed leg
Salman	9	5	Boy	Polio—right-hand side paralyzed, difficulty walking, and holding firmly

Being Indian, the first author (NG) approached this study as an insider with a cultural understanding of the study context and empathy for children demonstrated through 2 years of professional social work, fieldwork, and advocacy work for children’s inclusion in Mumbai. NG was also an outsider to the community, as he had returned from a foreign country. NG collected all data while in Mumbai, India. The other two research team members were not directly involved in data collection, although they supported NG during the data collection process through online and email communication. HA and BB are White Canadian researchers. HA is a qualitative researcher with significant experience in participatory research approaches and inclusive education in global contexts. BB has extensive experience related to the participation of children with disabilities in different contexts globally. She has developed methods to collect data directly with children, particularly those with physical and communication impairments who use alternative and augmentative communication.

Procedure

The methodology used in our study, and its application to children with physical disabilities in the Indian context, was based on the scaffolding approach (Heilmann, 2018). Scaffolding occurs when a knowledgeable adult provides support that advances students’ mastery of learning tasks (Chittooran, 2018; Heilmann, 2018). To ensure children’s voices were included, we employed a scaffolding approach to data collection comprising photograph elicitation, mental map drawing, and interviews. Our rationale for scaffolding originated from our interest in exploring how multiple approaches to online data collection might together achieve valid and rich findings from children with physical disabilities that have the potential to inform practice and qualitative research approaches (Chamberlain et al., 2011). Scaffolding methodologies are gaining increased recognition within educational literature. This paper will demonstrate how scaffolding multiple data collection methods using an online approach can be applied to qualitative research with children with physical disabilities to foster their engagement.

Activity 1: Online Researcher-Generated Photograph Elicitation

School visit and photography-the first author (NG) and Research Assistant (RA) initially visited the school and photographed the ‘activity settings’ without any children and their participation (due to COVID) to build a contextual understanding of children’s participation inside schools (Kontak et al., 2017). The activity setting is an activity-based contextualized setting (i.e., playing in the playground, socializing in the playground) that hosts child and youth activities and their participation (King et al., 2013). Moreover, activity settings are settings + activity (as the same activity happening in a different setting likely has a different meaning and leads to a different experience). We aimed for activity settings but photographed ‘silent’ activity settings—Thus, without activities happening in them (due to COVID). Yet we assumed these settings had meanings based on children’s experiences, as through experiences of participation that children shared, children could ‘make’ the photographs of settings into activity settings.

Zoom Sessions- NG later shared these photographs with the children in an online session and invited them to recall their participation experiences in those settings. We shared the photograph on the computer screen through the Zoom call and waited for the children to react. Children expressed excitement at seeing the photographs of their school spaces, as it had been seven months since they last went to school in person (see Figure 1). Phothongsunan (2010) indicated that by our very nature as human beings, we are able to communicate with one another, and in interpretative research, such forms of informal communication are given priority. This activity differed from the online interviews, as the photograph provided a space and visuals for children to revisit their participation context and share their participation experiences in an informal discussion. Furthermore, photographs facilitated the production of new knowledge that may not have been obtained through an in-person interview, without the visual prompts (Ortega-Alcazar, 2012). NG used semi-structured probes to discuss children’s experiences of participation and social interaction (see Table 2).

Figure 1.

An Author-Generated Photograph With Children’s Descriptions of Their Experiences Inside the Classroom. Source: Author

Table 2.

Tool for Photograph Elicitations

• Let us look at these photographs. Could you share your experience of taking part in school activities in each photo? (Prompt: playing, studying, etc.)

• Let us look at these photographs. Could you share how you used the spaces in each photo to connect with your friends and peers?

• What do you like about this place?

• What are your favourite things here?

• What do you like to do here?

• What would you like to do more of?

• What do you not like?

• What would you like to change?

Activity 2: Draw my Participation: the Online Mental Map Drawing

We utilized the mental map drawing technique to facilitate children’s self-expression of their experiences in school activity settings by involving them in art creation (Swienton et al., 2023). These maps were based on children’s participation memories inside school spaces (Gillespie, 2010). NG asked the children to draw three mental maps, trying to capture their experiences in educational (classroom), recreational (playground), and social (corridor) environments. There was no fixed order of drawing these maps, and children had a choice to pick and draw any maps in any order they liked. Once the children finished drawing, NG discussed the drawing with them to delve deeper into their experiences of participation and social interaction within the identified activity settings. Our primary aim was to use mental map drawing exercises with children to capture their participation experiences and understand how they negotiated school spaces. Children’s mental maps depicted the physical areas they enjoyed, such as interacting with their friends in the corridor. On the other hand, the maps also illustrated the spaces where children had negative experiences, for instance, feeling lonely in the classroom while other children were playing outside. We employed four steps to draw mental maps with children, including (a) the initial introduction to mental maps, (b) co-production with children, (c) making it a fun activity amidst the restriction of no social contact (COVID), and (d) making children accomplish tasks otherwise considered difficult. We discussed these steps in detail for researchers to refer to.

The Initial Introduction to Mental Maps

Before assigning tasks for drawing mental maps, NG, with the help of an RA (who was trained earlier in drawing mental maps and their purpose), informed the children about the mental maps drawing exercise. For example, as the data collection took place during COVID-19, NG, who was staying in the guest house, and an RA, who lived in the same community as the children, set up an hour-long Zoom video call from the children’s home. While the RA was in the community with the children, NG explained how to draw mental maps using a pen and a pre-determined mental map tool (see Table 3). NG provided the following prompt to each child: “Draw me a picture of you in your school space” (e.g., inside your classroom). Some prompts to explain the drawing process to children were: “You can think about how you took part in activities inside the classroom, playground, and corridor, going to the washroom, and using drinking water facilities, and draw that.” Table 2 offers the prompt and probing questions we used for the mental map activity with the children.

Table 3.

Showing an Example of a Mental Map Tool We Used in the Study

In the space below, draw how you participate in the classroom

Follow-up questions

1. What is the name of the place you have drawn?

2. Who is there in this drawing?

3. Where are you participating? Indoor/outdoor (circle anyone)

4. What are the objects in the drawing?

5. What do you not like in this space?

6. What do you like in this space?

7. What do you enjoy doing in this space?

8. What else could be there that can help you in taking part in activities in this space?

Co-Production With Children

NG and the RA collaborated with children, observed, and supported them when asked by clarifying any doubts about what to draw and how to draw. The RA encouraged children to express themselves freely and explained that they could take as much time as they wanted. Children indicated that they felt sad and were missing opportunities for interaction with their friends. NG reassured them, saying, “I can understand you felt sad; I would have also felt sad if I were you. I am here when you are ready to talk.” Such words allow children space to think and make them understand that you are there to make them feel safe (Conteh & Brock, 2011). NG and RA shared their experience of staying away from friends. RA stated, “We also cannot meet our friends, so we cannot go out and play with them. We can relate to what you are feeling.” Similar to Denham (2007), who indicated that validating children’s feelings is crucial for them to express themselves freely. The children drew three mental maps each: (i) a classroom, (ii) a corridor or washroom, and (iii) a playground or stage. The child took approximately 15 min to draw each mental map. Some children needed assistance in understanding and drawing mental maps. For clarification, we provided children with need-based instructions when asked (i.e., children asked about what they could draw for different activity settings). We encouraged them to think of their experiences of being in a particular setting, such as a ‘classroom.’ We provided the following prompt: “You can also draw what objects you remember in that space, with whom you are participating, and what other things you can imagine or have seen there.” It was a collaborative approach to understanding children’s participation experiences with minimal intervention from us.

Making it a Fun Activity Amidst the Restrictions of no Social Contact (COVID)

Many children enjoy drawing (Kendrick & McKey, 2016). The pandemic caused adverse changes in children’s activity levels (So et al., 2022), and drawing mental maps offered opportunities for children with physical disabilities to be physically involved in ‘doing'- a typical activity as it was pre-COVID. Children used this opportunity to draw and express themselves through the drawings they created. Research has previously shown that creative drawing exercises can be effective in giving children more control over or involvement in the data generation process (Carter & Ford, 2014). Mental map drawing was not a prolonged exercise. Children chose to take their time to draw the maps; we offered them support when asked and invited them to express themselves freely. Research has demonstrated that keeping the activity brief, making it enjoyable, and engaging in the activity together with children (Movahed et al., 2023; Newman, 2008; Stasch, 2014).

Children Accomplished Tasks Otherwise Considered Difficult by Others to Achieve Online

Some children took over 15 min to draw, and we encouraged them to express if they wanted to add anything to the mental maps they had created. Later, NG asked them to explain what they had drawn using the guiding questions (see Table 2); there was no set order of questions, as NG followed the flow of the conversation. This discussion took place 2 min after they finished drawing to explore their personal meaning attached to the place and its use (Gillespie, 2010; Trell & Van Hoven, 2010). The immediate follow-up conversation was designed to give children optimal space and time to reflect on their thoughts about the drawings. Also, to avoid losing the opportunity to tap into children’s feelings at that moment and their memories associated with the school. The entire process took 45 min to an hour for each child, and sometimes it took over one to two days, as children asked to continue the conversation on other days. It was challenging to continue the conversation from where we had left. NG took field notes about the discussions. We adapted the strategy and asked the children if they would be comfortable finishing the discussion that we had started about a particular mental map on that very day. For instance, NG stated- “I see you had difficulty concentrating and continuing the discussion. What can we do better next time?” Encouraging children to develop their own strategies for managing frustration empowered them to resolve their own challenges and seek assistance when needed. It also allowed children to practice identifying their feelings. The children suggested keeping the discussion short. These small achievements throughout the study process motivated us to continue our interactions and collect data.

Process of Online Photograph Elicitation and Mental Maps

We used the photograph discussion to understand the children’s participation context, support the findings, scaffold the children’s participation experiences, and develop case descriptions (Gaurav et al., 2024). We compared the mental maps using various parameters, including objects and figures, minimalist versus pluralist maps, and drawing style. We followed four steps to analyze the drawing. Below, we discuss strategies to analyze both photo elicitation and mental map drawings.

Photograph Elicitation as a Collaborative Approach

Photographs played a role in enabling children to recall certain things for their participation and social interaction or lead them to ponder in ways they had not done before (Ortega-Alcazar, 2012). For instance, the photograph presented by the researcher offered children visuals of their school spaces (i.e., the built environment, contextual features such as furniture, and the size and make of the space). It enabled us to discuss and document children’s experiences and explore what mattered to them. For instance, the photograph provided children with visuals of their school spaces (i.e., contextual features such as furniture, the built environment, and the size and make of the space). It enabled us to discuss and document children’s experiences, and explore issues of interest or matters that mattered to them. Researchers have used photographs as a ‘visual strategy’ to engage children with disabilities to support the conversation (Beukelman & Mirenda, 2012). Eliciting memories and reflections from photographs offered us various advantages, such as co-creation through a collaborative interaction between children and researchers in viewing the photographs (Kyololo e al., 2023; Ortega-Alcazar, 2012).

For instance, NG showed Salman the photograph of his classroom (see image 1) on the computer screen through the Zoom call and waited for him to react. Later, NG asked what activities Salman took part in that were related to the context of the photograph. Salman smiled and asked NG whether NG had visited their school. When NG confirmed, Salman stated- “That is our classroom. Sometimes, I play with my friends here. What other areas did you see in our school? Whom did you meet? Did you see the corridor? The corridor is my favorite place in school. I love playing and talking to my friends there.” These expressions were also indicative of children missing out on their engagement amidst limited social contact. NG further probed Salman to elaborate on “corridor” and “favorite place.” Salman indicated that “corridor” offered him a “safe space” to “chit-chat, share food, sit and play with his friends.” As he enjoyed interacting with his friends, Salman felt it was his favorite place. Children also discussed their experiences of participation in the school’s built environment and reported unique qualities of different activity settings. For instance, children indicated the corridor as a key space for informal interactions and relationship building, a finding similar to the findings of Teachman and Gibson (2018). Children also expressed their feelings of safety associated with physical support to hold on to while walking. For instance, Jyoti stated- “I have fallen quite a lot in the corridor. Sometimes, I do not go out due to this fear. If there is some rope or something to hold on to and walk, I can come out of class and play with my friends.” This example from Jyoti highlights her fear of falling and the feeling of isolation as linked to her meaning of participation, stemming from her prior negative experience.

All children also indicated what changes they wanted in the built environment, such as physical support to hold onto, non-slippery and level flooring, and larger spaces inside washrooms to enable them to participate freely.

The discussion of photographs helped children recall their experiences and feelings about the spaces. Children shared what they liked and disliked, as well as what enabled or restricted their participation. For example, after looking at the classroom photograph, Jyoti stated- “There is not much space between the two rows of furniture, and it is difficult to move inside the classroom freely with my crutches. I don’t like it; my friends mostly sit and talk in the back of the classroom.”

Salman shared that he “felt bored” studying in a “fixed pattern of seating arrangements” because it “limited his interaction with other children and friends.” Children further indicated that they would be happy to participate more if the classroom had a semi-circular or flexible seating arrangement, allowing them to move and rearrange furniture for seating. Other researchers have also reported that furniture arrangements in the classroom can both enable and limit children’s involvement (Valikhani, 2015). Daniels et al. (2018) indicated how setting informal boundaries with furniture inside the classroom and diverse arrangements increased engagement. Children in our study also discussed their spaces for shared activities near the classroom (i.e., corridors and areas near the staircase), which enabled them to share food with their friends, socialize, and play. These photo elicitation sessions allowed us to develop an understanding of children’s participation and social interaction experiences, as well as the meaning they gave to various activity settings, while navigating the built environments of the school.

Mental Maps Drawing Process

Before presenting our analysis strategy for mental maps, we illustrate an excerpt of how NG and Jyoti co-produced an understanding of the nature of participation and social interaction, as well as Jyoti’s experience of a classroom, through a discussion of her drawing.

NG: Great! Let us talk about your drawings. Could you tell me the name of the place you have drawn?

Jyoti: This is my classroom.

NG: What are the objects in the drawing?

Jyoti: The picture has a cupboard, a blackboard, a bench, and a door. The classroom also has a floor.

NG: When you come to your class, what are the things you like most about your class?

Jyoti: I like my classroom, but the benches and desks are a bit high for me, and sometimes it is difficult.

NG: Could you please describe what is difficult for you?

Jyoti: Yes! The difficulties include being unable to sit comfortably, getting in and out of the desk, and the height of the desks. Sometimes, I sit and see my friends play; I also want to play with them. I prefer to be seated. I feel that if I come out to play, I might fall.

NG: You said you find it difficult to get in and out of the furniture, which is uncomfortable. Could you tell me how it should be so that it is comfortable for you?

Jyoti: The benches [desks] should have a cushion, something soft to sit on, and they should be colorful and arranged according to height. Also, if two people could sit together, it would be great, as I could talk to my friend sitting with me. I do not like independent benches and desks.

NG: You said you like your classroom. What do you like about it?

Jyoti: I like the window, but it could be a bit bigger. I like seeing things outside; I can see my friends playing outside. I also like the blackboard; I sit in the front, so it is easy for me to see what is written on the blackboard.

NG: What do you not like about your classroom?

Jyoti: I do not like the flooring. That's why I have not drawn it. It's uneven, and sometimes I fall while walking on it. Particularly near where I sit, it's broken and uneven.

NG: Okay! How would the flooring be like that would help you?

Jyoti: It should not even (be leveled) all over, and it should be colorful and designed.

In the question that begins the above excerpt, NG tries to steer Jyoti toward the built space and her experiences of navigating through it. Jyoti responds by indicating the objects in her drawing and how she finds it difficult inside the classroom. NG further probes to understand the meaning of the challenges she experienced. Jyoti relates her “difficulty” to her feeling of “inability to access and use the desk with ease” [observation: in Mumbai’s community schools, all the desks are of the same height, irrespective of children’s varying heights and needs] and how that ‘limits her participation and social interaction’ with her friends inside the classroom. Jyoti also discusses how her feeling of inability is a product of how the desks are designed, sometimes forcing her to “stay alone” and “watch her friends play.” [This is similar to the discussion of the photograph with Jyoti and Salman] NG probes again to explore Jyoti’s ideas for an improved desk design that could enable her to get involved, ‘play’, and ‘chit-chat’ with her friends. Jyoti responds by associating the component of comfort with ease of participation, such as desks “should have a cushion” and “something soft to sit on.” She adds that the desks should be “colourful and arranged according to students’ height.” She also expresses how she does not like her present desk, which limits her to sitting alone. She indicates that some minor modifications and provisions, such as “if two people could sit together, it would be great, as I could talk to my friend sitting with me,” can offer her space for social interaction, which she identified as most important to her. The discussion continues, and Jyoti further discusses her dislike for the classroom flooring: “I do not like the flooring,” and she relates it to her bad experience of falling. Jyoti further indicated that she did not intentionally draw it as “it is [the flooring] uneven, and sometimes I fall while walking on it.” The excerpt presented above is of analytical interest and illustrates how Jyoti related her artwork to her meaning of participation and social interaction experiences. Other researchers also suggested that children needed time and space to reflect on their experiences (Mah et al., 2024). In our study, the earlier photograph elicitation session acted as the space where trust and a sense of participation, as illustrated by Jyoti’s example. Teachman and Gibson (2013) also highlighted that the co-production of meaning from children’s participation experiences required trust and a sense of comfort.

Data Analysis

Data Management and Familiarization

All photograph elicitation and mental map discussions were video and audio-recorded and transcribed verbatim in Hindi (the original language). Yin (2015) also suggests conducting analysis in the original language to minimize data loss. Transcripts were supported by detailed field notes recorded during and immediately after each session (Fearnley, 2022; Phillippi & Lauderdale, 2018). Transcripts were cross-checked against these field notes to ensure accuracy and to capture contextual details such as pauses, gestures, and expressions. Drawings (mental maps) were photographed and stored alongside transcripts. NG read and re-read transcripts while reviewing the children’s drawings and photographs (school spaces) to become closely familiar with the data (Figure 2).

Figure 2.

Jyoti’s Representation of her Participation Experience Inside the Classroom

Thematic Interpretation and Meaning Making

Interpretation involved more than categorizing data; it required making sense of what children’s words and images (they drew) revealed about their participation experiences. For example, Jyoti’s deliberate omission of the classroom floor in her drawing, coupled with her verbal account of falling, was interpreted as a symbolic resistance to unsafe physical environments. This act of “not drawing” was analytically significant, indicating spatial discomfort and emotional disconnect. Such insights emerged through our iterative engagement with visual and verbal data in context. For example, a 9-year-old girl drew human figures and discussed her social interaction experiences with friends in the corridor (see Figure 3). She stated- “I cannot walk far, so my friends come and chit-chat with me in the corridor. I love talking to them, and we share our tiffin (lunch) with them.” Similarly, repeated references to the corridor as a “safe space” or a site for “chit-chat and sharing food” led us to understand informal school spaces as central to children’s sense of belonging and agency. These interpretations demonstrate how the drawing of a corridor became a symbol of “freedom” or “safety”.

Figure 3.

Komal’s Representation of her Social Interaction Experience Inside the Corridor

We also examined the interplay between different modalities. A child might draw an empty classroom, yet describe it as “lonely” or “boring”—indicating a disconnection not visible in the image alone. In this way, drawings became entry points to richer interpretative discussions, revealing aspects of children’s emotional landscapes within school spaces (Figures 4 and 5).

Figure 4.

(Left): Shadab’s Representation of his Social Isolation Inside the Classroom During Recess

Figure 5.

(Right): Salman’s Representation of Playing With Friends in the Playground

Cross-Model Integration and Trustworthiness

To strengthen the credibility of our interpretations, we triangulated across drawings, verbal explanations, research field notes, and photo-elicitation. For instance, when Komal depicted the corridor with several figures and shared her joy in socializing there, her drawing supported earlier discussions in which she emphasized the corridor as a space for peer bonding. These forms of integration helped validate the findings and ground the interpretations in the complete data set. We organized reflective discussions within the research team to test assumptions and refine themes. Memos and analytic summaries were used to document our evolving interpretations. This iterative process enabled us to move beyond description and toward deeper insights into children’s experiences of school participation and social interaction. Our analysis process combined rigorous data preparation, systematic coding, and interpretative engagement with both visual and verbal data. This approach allowed us to construct a nuanced understanding of children’s experiences in ways that honored their agency, creativity, and contextual realities in an LMIC.

Discussion

Our analysis highlighted both the lived realities of children with physical disabilities in Mumbai and the methodological value of adapting participatory and creative methods in online mode in LMIC contexts. Beyond providing insights into children’s participation, the process of combining photo elicitation and mental maps online demonstrated how creative methods can sustain children’s voices even when they are physically excluded from their everyday spaces, such as during the COVID-19 pandemic. These findings underscore the dual contribution of this study: advancing substantive knowledge about social participation and inclusion in low-resource school environments, while also offering transferable methodological lessons on how participatory research can be adapted and made meaningful in contexts where infrastructural and cultural constraints often silence children.

In interpreting these findings, we drew from Hammel et al.'s (2008) definition of meaningful participation and Sharma’s (1996) definition of social interaction, situating children’s accounts within established theoretical understandings of engagement and inclusion. The visual methods employed in this study provided an important window into how children interpreted participation in their own terms, ranging from feelings of safety and mobility in navigating built environments to the informal peer connections that gave them a sense of belonging. The methods also created opportunities for children to articulate what meaningful engagement looked like for them, thereby extending beyond oversimplified assumptions of “voice” in child-focused research (Facca et al., 2020; Mah et al., 2024; Teachman & Gladstone, 2020).

Our findings extend beyond the specific case of Mumbai and speak to the broader field of global disability research by highlighting the importance of methodological flexibility in low- and middle-income contexts. The study demonstrates that participatory and creative online approaches can be successfully adapted even in settings where limited infrastructure, constrained digital access, and cultural norms around children’s participation often pose barriers. For instance, the involvement of a local research assistant fluent in the community’s local language was not merely a logistical adjustment but a methodological necessity that ensured trust-building, cultural resonance, and children’s comfort. Similarly, the adaptations of the activity prompts (e.g., substituting local terms such as “gallery” for “corridor”) demonstrate how small yet contextually informed shifts can enhance the inclusivity of participatory research. These methodological insights foreground the need for researchers to acknowledge, rather than bypass, the resource realities of LMICs, and to integrate these constraints as central to their study design.

Importantly, the methodological lessons learned in Mumbai have relevance for other LMIC settings where children with disabilities are frequently excluded from research. Strategies such as scaffolding multiple creative methods, aligning research activities with children’s daily routines, and validating children’s emotions to foster safe participation are adaptable and transferable across diverse cultural and infrastructural contexts. By explicitly situating methodological innovations within the realities of LMICs, our study contributes to shifting the research agenda towards a more inclusive and globally relevant practice of disability research. In doing so, we respond to calls for decolonizing methodological approaches and ensuring that the perspectives of children in low-resource settings inform global knowledge production. These insights position LMICs not as sites of deficit but as contexts where methodological ingenuity can flourish, offering lessons that can enrich research practice worldwide.

Lessons Learned in Conducting Online Research in the LMIC Context

Building Trust, Co-Producing Knowledge, and Community Engagement

Establishing local contacts was essential in overcoming barriers to participation. In Mumbai, the involvement of a local research assistant (RA) who was fluent in community languages and English helped us mitigate gatekeeping by families, facilitated trust with children, and ensured cultural resonance. In India and Mumbai, it is a cultural practice that children are discouraged from talking to strangers outside their community due to safety concerns. The RA’s presence addressed safety concerns commonly associated with children speaking to outsiders, while also enabling parents to feel comfortable with their child’s participation. This highlights a transferable lesson for researchers working in LMIs and cross-cultural research: engaging trusted community intermediaries is ethical and methodologically critical for facilitating children’s participation in research.

A Flexible and Culturally Sensitive Approach

During the initial community visits, we learned and modified our approaches, such as using a laptop within the community for online sessions. The presence of a local RA facilitated necessary cultural and technology-related adaptations. For instance, we learned that we could arrange Zoom calls with children but would need to use our computer/laptop and a portable internet device. The RA needed to be present with the family to facilitate these online sessions from the community. Adapting the research approach to children’s daily lives was central to sustaining engagement in the LMIC context. For example, scheduling sessions around children’s online school commitments and negotiating session length addressed fatigue and disengagement, which were common challenges during the pandemic. We prioritized working around children’s schedules to ensure they were not overburdened and overwhelmed. For instance, during the Zoom call, the children informed us that they would not participate for a prolonged period, as they also had online classes. They indicated feeling bored and exhausted. Other studies reported that children’s online participation challenges included exhaustion, boredom, and missing in-person connections (Brehm et al., 2021; Gaurav, 2024; Massner, 2022). Culturally sensitive adaptations, such as using locally familiar terms, also reduced confusion and enhanced comfort. These adjustments illustrate how methodological flexibility in LMICs requires attentiveness to infrastructure, cultural norms, and the child’s daily routine.

Creating Safe and Engaging Spaces for Expression

Patience and validation of children’s emotions are vital (Bodang & Lengkat, 2021). In our work, we aligned with Conteh and Brock (2011) by acknowledging children’s feelings without judgment in order to create a safe environment for open discussion and fostering deeper engagement. For instance, we waited for the children’s response, smiled, and acknowledged their thoughts/ideas without interrupting them. Similarly, recent research has indicated that acknowledging children’s feelings and emotions and validating them helps create a safe space for them to discuss and engage online (Durham et al., 2019; Mah et al., 2024). Additionally, sharing personal stories related to the children’s current experiences (e.g., social distancing) helped us establish rapport. This approach encouraged shy children to open up, highlighting the importance of relevant connections (Teachman & Gibson, 2013, 2018). For instance, NG and RA shared how they spent their days during social distancing, which encouraged children to speak up, as they also had something to share on this topic. We connected with children over shared interests and common experiences. Using photographs as conversation starters allowed children in our study to reconnect with meaningful places, enhancing their willingness to share their participation experiences. As reported in previous research, the photograph elicitation effectively engaged children by prompting recall and reflection (McLaughlin & Coleman-Fountain, 2014). For example, by showing the photos to children, we were able to reconnect them with their school-built space that holds meaning based on their experience; seeing their ‘place’ helped children recall the events, activities, interactions, and feelings—their experiences in built spaces—which enabled us to gather rich data on their social participation and inclusion. Moreover, the discussion helped build curiosity among the children to participate and talk about their school. Similarly, there has been an emphasis on in-person use of visual methods to engage children, such as photograph elicitation, where the researcher invites children to talk about pictures they took or the ones presented to them by the researcher (Clark-Ibanez, 2008; Kaplan, 2009). Our research has shown that this approach can also be effective when conducted virtually.

Encouraging Space for Reflection and Managing Engagement

Providing children with opportunities to pause, reflect, and return to tasks supports a richer account of their participation experiences. Researchers have argued that providing children with time to reflect on their thoughts and feelings, especially during creative activities such as drawing, enhances engagement and expression (Aitken & Millar, 2002; Movahed et al., 2023). Short breaks can also motivate involvement in such activities (Hayes, 2009). For our study, when the children drew the mental maps, we asked them if they wanted to add something to it once they were done. We took 2 min before we began discussing the mental map drawing. This aligns with research that demonstrates taking breaks can motivate children’s involvement in creative activities, such as drawing (Bodang & Lengkat, 2021; Hayes, 2009; Movahed et al., 2023). The methodological implications are that in LMIC contexts—where digital fatigue, resource constraints, and competing household demands may be pronounced—creative pacing and iterative engagement strategies are crucial for sustaining meaningful participation.

Limitations and Challenges

Conducting mental map drawing sessions online in a synchronized session can have multiple challenges. For example, children have been found to have limited attention spans online, so the time available to collect meaningful data from the children was more limited than with adults. Creative methods, such as drawings, enhance children’s genuine engagement and fun, which is essential for maintaining their attention. Beyond the challenges of limited attention spans, in some instances, our study found that children would not respond to the discussion points, which we assumed could be due to how we formulated the question or how children understood it. In these instances, we adapted the language to be contextually/culturally relevant, and paraphrased the sentences to enhance children’s understanding. For example, we changed some wordings such as, ‘corridor’ to ‘gallery’, ‘washroom’ to ‘toilet’, ‘recess’ to ‘lunchtime’. Also, since the conversation was in Hindi, NG had to use some local and commonly used terms such as- ‘Sandas’ for ‘toilet’, ‘gallary’ for ‘corridor’, ‘maidan’ for ‘playground’, ‘Jeena’ for ‘staircase’. Another limitation of our study was that we did not provide colour pens to children while they drew the mental maps. Children might have had used colours to potentially add different dimensions to the meaning of their participation. Another limitation of our study was that we took photographs during lockdown, and they represented school spaces with children. It could have been potentially easier to initiate a discussion about the children’s activity setting if the photographs had included children.

Future Directions

We employed scaffolding and data triangulation to gain an understanding of children’s contextual experiences in negotiating the school’s built environment. A deeper understanding of creative methods to engage children online, combined with diverse approaches for prolonged engagement, could potentially yield an in-depth understanding of their experiences. In addition, revisiting children’s drawings and exploring them with children in repetitive sessions could offer better insights into their experiences connected to their drawings. Researchers could also involve friends or peers of children with disabilities in drawing and discussions to get insight into the transactional process of social and peer interaction. We only focused on children with physical disabilities; amongst them, none had significant challenges with manual abilities, holding objects, grip, or fine motor skills. Future studies could use the combination of visual methods to explore the experiences of children with diverse disabilities and communication difficulties. While a brief pause was offered between drawing and discussion, future research may explore longer reflection windows. Some children noted fatigue, suggesting that even enjoyable activities can be exhausting in constrained online settings.

Conclusion

This study reflected on the use of participatory and creative online approaches—specifically, researcher-generated photo elicitation and mental map drawing—to engage children with physical disabilities in Mumbai, India. By adapting these methods to the constraints of the COVID-19 pandemic and to the realities of a low- and middle-income context, we demonstrated that children’s perspectives on participation and social interaction can be meaningfully accessed even when in-person engagement is not possible. Notably, the study highlighted that these methods did more than generate data: they created safe and enjoyable spaces for children to reflect, express themselves, and reconnect with their school environments during a time of physical exclusion.

Our analysis offered insights about the methodological value of combining participatory and creative approaches in LMIC contexts. The lessons learned in Mumbai are not context-bound but transferable. Building trust through community intermediaries, adapting methods to cultural norms and children’s routines, validating emotions to foster a safe space, and offering flexibility for reflection are strategies that can inform research in other low-resource settings. By documenting these adaptations, we contribute to methodological guidance for disability research in LMICs, where infrastructural, technological, and cultural constraints often silence children’s voices. Our study positions LMIC contexts not only as sites of constraints but also as places where methodological innovations can emerge. We hope that these insights encourage researchers to adopt, adapt, and extend participatory and creative online approaches in ways that make children’s perspectives central to disability research globally. Thus, contributing to a more inclusive and contextually responsive body of knowledge.

Footnotes

Acknowledgments

We would like to thank the Brihanmumbai Municipal Corporation (BMC), Akash Shekapure (RA), school teachers, children with physical disabilities, and their parents for their contributions to this study.

ORCID iD

Navjit Gaurav

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the Queen Elizabeth II Scholars program. This publication is supported in part, thanks to funding from the Canada Research Chairs Program and funding from the Government of Canada’s New Frontiers in Research Fund (NFRFE-2021-00200).

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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Adapting Participatory and Creative Online Approaches in Low- and Middle-Income Context: Engaging Children With Physical Disabilities in Mumbai,India

Abstract

Keywords

Introduction

Children’s Voices in Qualitative Research

About the Study

Methodological Adaptability

(a) Planned In-Person Methods

(b) Methods Selected in the Context of the Pandemic

(c) Adaptation to an Online Environment

Synopsis of Research

Procedure

Activity 1: Online Researcher-Generated Photograph Elicitation

Activity 2: Draw my Participation: the Online Mental Map Drawing

The Initial Introduction to Mental Maps

Co-Production With Children

Making it a Fun Activity Amidst the Restrictions of no Social Contact (COVID)

Children Accomplished Tasks Otherwise Considered Difficult by Others to Achieve Online

Process of Online Photograph Elicitation and Mental Maps

Photograph Elicitation as a Collaborative Approach

Mental Maps Drawing Process

Data Analysis

Data Management and Familiarization

Thematic Interpretation and Meaning Making

Cross-Model Integration and Trustworthiness

Discussion

Lessons Learned in Conducting Online Research in the LMIC Context

Building Trust, Co-Producing Knowledge, and Community Engagement

A Flexible and Culturally Sensitive Approach

Creating Safe and Engaging Spaces for Expression

Encouraging Space for Reflection and Managing Engagement

Limitations and Challenges

Future Directions

Conclusion

Footnotes

Acknowledgments

ORCID iD

Funding

Declaration of Conflicting Interests

References