Identifying solutions to increase participation in physical activity interventions within a socio-economically disadvantaged community: a qualitative study

International Journal of Behavioral Nutrition and Physical Activity

Margaret E Cupples²  Lindsay Prior³  Michael Donnelly¹  Frank Kee¹  David Scott¹  Mark A Tully¹  Ruth F Hunter¹  Claire L Cleland⁴ 

[1] UKCRC Centre of Excellence for Public Health (Northern Ireland), School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Clinical Sciences Block B, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BJ, UK;Department of General Practice and Primary Care, Queen’s University Belfast, 1 Dunluce Avenue, Belfast BT9 7HR, UK;The School of Sociology, Social Policy and Social Work, Queen's University of Belfast, 6 College Park, Belfast, Northern Ireland BT7 1LP, UK;MRC/CSO Social and Public Health Sciences, University of Glasgow, Top floor, 200, Renfield Street, Glasgow G2 3QB, UK

关键词: Cross-sector working;    Communication;    Health information;    Qualitative;    Public health;    Community;    Socio-economic disadvantage;    Interventions;    Physical activity;   

Others  :  803464
DOI  :  10.1186/1479-5868-11-68

 received in 2013-11-15, accepted in 2014-05-14,  发布年份 2014

【 摘 要 】

Background

There is an urgent need to increase population levels of physical activity, particularly amongst those who are socio-economically disadvantaged. Multiple factors influence physical activity behaviour but the generalisability of current evidence to such ‘hard-to-reach’ population subgroups is limited by difficulties in recruiting them into studies. Also, rigorous qualitative studies of lay perceptions and perceptions of community leaders about public health efforts to increase physical activity are sparse. We sought to explore, within a socio-economically disadvantaged community, residents’ and community leaders’ perceptions of physical activity (PA) interventions and issues regarding their implementation, in order to improve understanding of needs, expectations, and social/environmental factors relevant to future interventions.

Methods

Within an ongoing regeneration project (Connswater Community Greenway), in a socio-economically disadvantaged community in Belfast, we collaborated with a Community Development Agency to purposively sample leaders from public- and voluntary-sector community groups and residents. Individual semi-structured interviews were conducted with 12 leaders. Residents (n = 113), of both genders and a range of ages (14 to 86 years) participated in focus groups (n = 14) in local facilities. Interviews and focus groups were recorded, transcribed verbatim and analysed using a thematic framework.

Results

Three main themes were identified: awareness of PA interventions; factors contributing to intervention effectiveness;and barriers to participation in PA interventions. Participants reported awareness only of interventions in which they were involved directly, highlighting a need for better communications, both inter- and intra-sectoral, and with residents. Meaningful engagement of residents in planning/organisation, tailoring to local context, supporting volunteers, providing relevant resources and an ‘exit strategy’ were perceived as important factors related to intervention effectiveness. Negative attitudes such as apathy, disappointing experiences, information with no perceived personal relevance and limited access to facilities were barriers to people participating in interventions.

Conclusions

These findings illustrate the complexity of influences on a community’s participation in PA interventions and support a social-ecological approach to promoting PA. They highlight the need for cross-sector working, effective information exchange, involving residents in bottom-up planning and providing adequate financial and social support. An in-depth understanding of a target population’s perspectives is of key importance in translating PA behaviour change theories into practice.

【 授权许可】

   
2014 Cleland et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Lee IM, Skerrett PJ: Physical activity and all-cause mortality: what is the dose-response relation? Med Sci Sports Exerc 2001, 33:459-471.
• [2]Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT: Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 2012, 380:219-229.
• [3]World Health Organization: World Health Organization Steps to Health: A European Framework to Promote Physical Activity for Health. [http://www.euro.who.int/__data/assets/pdf_file/0020/101684/E90191.pdf webcite]
• [4]Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U: Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 2012, 380:247-257.
• [5]Kohl HW, Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, Kahlmeier S: The pandemic of physical inactivity: global action for public health. Lancet 2012, 380:294-305.
• [6]Everson-Hock ES, Johnson M, Jones R, Woods HB, Goyder E, Payne N, Chilcott J: Community-based dietary and physical activity interventions in low socioeconomic groups in the UK: A mixed methods systematic review. Prev Med 2013, 56:265-272.
• [7]Heath GW, Parra DC, Sarmiento OL, Andersen LB, Owen N, Goenka S, Mantes F, Brownson RC: Evidence-based intervention in physical activity: lessons from around the world. Lancet 2012, 380:272-281.
• [8]Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJF, Martin BW: Correlates of physical activity: why are some people physically active and others not? Lancet 2012, 380:258-271.
• [9]Hillsdon M, Foster C, Cavill N, Crombie H, Naidoo B: A Review of the Evidence on the Effectiveness of Public Health Interventions for Increasing Physical Activity amongst Adults: A Review of Reviews. London: Health Development Agency; 2005.
• [10]Marcus BH, Williams DM, Dubbert PM, Sallis JF, King AC, Yancey AK, Franklin BA, Buchner D, Daniels SR, Clayton RP: Physical activity intervention studies: what we know and what we need to know: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (subcommittee on Physical Activity); Council on Cardiovascular Disease in the Young; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research. Circulation 2006, 114:2739-2752.
• [11]Cleland CL, Tully MA, Kee F, Cupples ME: The effectiveness of physical activity interventions in socio-economically disadvantaged communities: a systematic review. Prev Med 2012, 54:371-380.
• [12]Foster CE, Brennan G, Matthews A, McAdam C, Fitzsimons C, Mutrie N: Recruiting participants to walking intervention studies: a systematic review. Int J Behav Nutr Phys Act 2011, 8:137. BioMed Central Full Text
• [13]World Health Organization: Physical activity promotion in socially disadvantaged groups: principles for action. PHAN Work Package 4 Final Report. [http://www.euro.who.int/_data/assets/pdf_file/0005/185954/E96817eng.pdf webcite]
• [14]Cerin E, Leslie E: How socio-economic status contributes to participation in leisure-time physical activity. Soc Sci Med 2008, 66:2596-2609.
• [15]Leischow SJ, Best A, Trochim WM, Clark PI, Gallagher RS, Marcus SE, Matthews E: Systems thinking to improve the public’s health. Am J Prev Med 2008, 2:S196-S203.
• [16]Petticrew M, Anderson L, Elder R, Grimshaw J, Hopkins D, Hahn R, Krause L, Kristjansson E, Mercer S, Sipe T, Tugwell P, Ueffing E, Waters E, Welch V: Complex interventions and their implications for systematic reviews: a pragmatic approach. J Clin Epidemiol 2013, 66:1209-1214.
• [17]Petticrew M, Rehfuess E, Noyes J, Higgins JPT, Mayhew A, Pantoja T, Shemilt I, Sowden A: Synthesizing evidence on complex interventions: how meta-analytical, qualitative, and mixed-method approaches can contribute. J Clin Epidemiol 2013, 66:1230-1243.
• [18]Tully MA, Hunter R, McAneney H, Cupples ME, Donnelly M, Ellis G, Hutchinson G, Prior L, Stevenson M, Kee F: Physical activity and the rejuvenation of Connswater (PARC study): protocol for a natural experiment investigating the impact of urban regeneration on public health. BMC Public Health 2013, 13:774. BioMed Central Full Text
• [19]Northern Ireland Statistics and Research Agency: Northern Ireland Multiple Deprivation Measure 2010. [http://www.nisra.gov.uk/deprivation/nimdm_2010.htm webcite]
• [20]Braun V, Clarke V: Using thematic analysis in psychology. Qual Res Psychol 2006, 3:77-101.
• [21]Taylor GW, Ussher JM: Making sense of S&M: a discourse analytic account. Sexualities 2001, 4:293-314.
• [22]Irwin A, Scali E: Action on the social determinants of health: learning from previous experiences. Discussion Paper 1 Social Determinants of Health (Debates). [http://apps.who.int/iris/bitstream/10665/44488/1/9789241500876_eng.pdf webcite]
• [23]NICE Public Health Co-ordinating Centre: Physical Activity and Children: Review 3. The views of children on barriers and facilitators to physical activity: a review of qualitative studies. Version 4. [http://www.nice.org.uk/media/C7D/AB/PromotingPhysicalActivityChildrenReview3QualitativeCorrelates.pdf webcite]
• [24]Loewensen R: Evaluating intersectoral processes for action on the social determinants of health: learning from key informants. Social Determinants of Health Discussion Paper 5: policy and practice. [http://apps.who.int/iris/bitstream/10665/84373/1/9789241505369_eng.pdf webcite]
• [25]Burgoyne L, Woods C, Coleman R, Perry IJ: Neighbourhood perceptions of physical activity: a qualitative study. BMC Public Health 2008, 8:101. BioMed Central Full Text
• [26]Michie S, van Stralen MM, West R: The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci 2011, 6:42. BioMed Central Full Text
• [27]Simons L: Diversity and inclusion: what’s it about and why is it important for public health research? [http://www.invo.org.uk/wp-content/uploads/2012/10/INVOLVEDiversityandInclusionOct2012.pdf webcite]
• [28]Krishnaswami J, Martinson M, Wakimoto P, Anglemeyer A: Community-engaged interventions on diet, activity, and weight outcomes in U.S. schools: a systematic review. Am J Prev Med 2012, 43:81-91.
• [29]Mummery WK, Brown WJ: Whole of community physical activity interventions: easier said than done. Br J Sports Med 2009, 43:39-43.
• [30]Kok G, Schaalma H, Ruiter RA, Van Empelen P, Brug J: Intervention mapping: protocol for applying health psychology theory to prevention programmes. J Health Psychol 2004, 9:85-98.