Mechanisms of Change for Children Participating in Therapeutic Horse Riding: A Grounded Theory

Aim: To develop a model for understanding mechanisms of change in health outcomes for riders with disabilities participating in therapeutic horse riding (THR). Methods: Using grounded theory methods we collected and analyzed data from interviews with 16 child riders and 18 caregivers, teachers and primary therapists, and from participant-observation during THR sessions. Results: The central concept underpinning the model illustrating mechanisms of change was gaining the tools to go on. Riders' experiences suggested the THR landscape (i.e., where the tools are gathered) allowed for an expanded range of experiences in which riders could participate. Riders experienced an expansion of self-concept by learning to move, succeed, connect, and adapt (i.e., the tools gathered) within the THR landscape. Riders then iteratively translated an expanded view of self into other environments, reflecting how and where the tools are used. Conclusion: Findings suggest that positive changes in health arise from riders' experiences of learning and agency within the THR therapeutic landscape, and from the influence of these experiences on a child's developing self-concept. This article considers the wider impact of THR on children's health, beyond a focus on changes in physical outcomes.