Factors influencing attendance in a structured physical activity program for Aboriginal and Torres Strait Islander women in an urban setting: a mixed methods process evaluation

International Journal for Equity in Health

Margaret Cargo¹  Robyn A McDermott¹  Belinda Spagnoletti¹  Karla J Canuto¹ 

[1] Sansom Institute for Health Research, University of South Australia, Adelaide, Australia

关键词: Participation;    Facilitators;    Barriers;    Health promotion;    Lifestyle program;    Women;    Physical activity;    Torres Strait Islander;    Aboriginal;   

Others  :  825141
DOI  :  10.1186/1475-9276-12-11

 received in 2012-11-08, accepted in 2013-01-22,  发布年份 2013

【 摘 要 】

Background

Aboriginal and Torres Strait Islander women experience higher rates of obesity, chronic disease, and are less active than non-Indigenous Australian women. Lifestyle programs designed to increase physical activity and encourage healthy eating are needed to ameliorate this disparity. The aim of this study was to identify participants’ perceived barriers and enablers to attend group exercise classes as part of a 12-week fitness program.

Methods

To understand the factors that influence attendance, a mixed method process evaluation was undertaken in which a quantitative measure of attendance in the group exercise classes was used to identify cases for further qualitative investigation. Aboriginal and/or Torres Strait Islander women aged 18 to 64 years were recruited to a research trial of a fitness program. The 12-week program included two 60-minute group exercise classes per week, and four nutrition education workshops. Semi-structured interviews were conducted at program completion. Participants were stratified by attendance, and interviews from the highest and lowest 25 percentiles analysed. Rigour was strengthened through use of multiple data analysts, member checking and prolonged engagement in the field.

Results

Analyses of the post-program interviews revealed that participants enrolled in the program primarily for the perceived health benefits and all (with one exception) found the program met their needs and expectations. The atmosphere of classes was positive and comfortable and they reported developing good relationships with their fellow participants and program staff. Low attendees described more barriers to attendance, such as illness and competing work and family obligations, and were more likely to report logistical issues, such as inconvenient venue or class times.

Conclusions

Attendance to the ‘Aboriginal and Torres Strait Islander Women’s Fitness Program’ was primarily influenced by the participant’s personal health, logistics and competing obligations. Low attendees reported more barriers during the 12-week period and identified fewer enabling factors than high attendees.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12610000224022

【 授权许可】

   
2013 Canuto et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Australian Institute of Health and Welfare: Australia's health 2010, A.I.o.H.a. Welfare. Canberra: Australian Institute of Health and Welfare; 2010.
• [2]Australian Institute of Health and Welfare: Aboriginal and Torres Strait Islander health performance framework 2010: detailed analyses, A.I.o.H.a. Welfare. Canberra: Australian Institute of Health and Welfare; 2011.
• [3]Warburton DER, Nicol CW, Bredin SSD: Prescribing exercise as preventive therapy. Can Med Assoc J 2006, 174(7):961-974.
• [4]Shaw K, et al.: Exercise for overweight or obesity. Cochrane Database Syst Rev 2006, 4:CD003817.
• [5]Mertens IL, Van Gaal LF: Overweight, obesity, and blood pressure: the effects of modest weight reduction. Obesity 2000, 8(3):270-278.
• [6]Neter JE, et al.: Influence of weight reduction on blood pressure. Hypertension 2003, 42(5):878-884.
• [7]Orozco L, et al.: Exercise or exercise and diet for preventing type 2 diabetes mellitus. Cochrane Database Syst Rev 2008.
• [8]Satterfield DW, et al.: Community-based lifestyle interventions to prevent type 2 diabetes. Diabetes Care 2003, 26(9):2643-2652.
• [9]Snowling NJ, Hopkins WG: Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients. Diabetes Care 2006, 29(11):2518-2527.
• [10]Anand SS, et al.: A family-based intervention to promote healthy lifestyles in an Aboriginal community in Canada. Can J Public Health 2007, 98(6):447-452.
• [11]Archer SL, et al.: Associations of community-based health education programs with food habits and cardiovascular disease risk factors among Native Americans with diabetes: the inter-tribal heart project, 1992 to 1994. J Am Diet Assoc 2002, 102(8):1132-1135.
• [12]Armstrong DL: A community diabetes education and gardening project to improve diabetes care in a Northwest American Indian tribe. Diabetes Educ 2000, 26(1):113-120.
• [13]Bachar JJ, et al.: Cherokee Choices: a diabetes prevention program for American Indians. Prev Chronic Dis 2006, 3(3):A103.
• [14]Chan LCK, et al.: Short term efficacy of a lifestyle intervention programme on cardiovascular health outcome in overweight Indigenous Australians with and without type 2 diabetes mellitus: The healthy lifestyle programme (HELP). Diabetes Res Clin Pract 2007, 75(1):65-71.
• [15]Clifford A, et al.: Smoking, nutrition, alcohol and physical activity interventions targeting Indigenous Australians: rigorous evaluations and new directions needed. Aust N Z J Public Health 2011, 35(1):38-46.
• [16]Egger G, et al.: Abdominal obesity reduction in Indigenous men. Int J Obes Relat Metab Disord 1999, 23(6):564-569.
• [17]Ho LS, et al.: An integrated multi-institutional diabetes prevention program improves knowledge and healthy food acquisition in northwestern Ontario First Nations. Health Educ Behav 2008, 35(4):561-573.
• [18]Leonard B, Leonard C, Wilson R: Zuni Diabetes Project. Public Health Rep 1986, 101(3):282-288.
• [19]McAuley KA, et al.: Implementation of a successful lifestyle intervention programme for New Zealand Maori to reduce the risk of type 2 diabetes and cardiovascular disease. Asia Pac J Clin Nutr 2003, 12(4):423-426.
• [20]Narayan KM, et al.: Randomized clinical trial of lifestyle interventions in Pima Indians: a pilot study. Diabet Med 1998, 15(1):66-72.
• [21]Rowley KG, et al.: Effectiveness of a community-directed "healthy lifestyle" program in a remote Australian Aboriginal community. Aust N Z J Public Health 2000, 24(2):136-144.
• [22]Simmons D, Voyle JA: Reaching hard-to-reach, high-risk populations: piloting a health promotion and diabetes disease prevention programme on an urban marae in New Zealand. Health Promot Int 2003, 18(1):41-50.
• [23]Wilson RH, et al.: A low-cost competitive approach to weight reduction in a Native American community. Int J Obes 1987, 13(6):731-738.
• [24]Wing RR, et al.: Achieving weight and activity goals among diabetes prevention program lifestyle participants. Obes Res 2004, 12(9):1426-1434.
• [25]McNamara BJ, et al.: Type 2 diabetes in Indigenous populations: Quality of intervention research over 20 years. Prev Med 2011, 52(1):3-9.
• [26]Chen HT: Practical program evaluation: assessing and improving planning, implementation, and effectiveness. Thousand Oaks, CA: Sage; 2005.
• [27]Steckler A, et al.: Toward integrating qualitative and quantitative methods: an introduction. Health Education Quartley 1992, 19(1):1-8.
• [28]Rossi PH, Freeman HE, Lipsey MW: Evaluation: a systematic approach. 7th edition. Thousand Oaks, CA: Sage; 2004:470.
• [29]Canuto K, et al.: Study protocol: a pragmatic randomised controlled trial of a 12-week physical activity and nutritional education program for overweight Aboriginal and Torres Strait Islander women. BioMed Central Public Health 2011, 11(1):655.
• [30]Canuto KJ, et al.: Pragmatic randomised trial of a 12-week exercise and nutrition program for Aboriginal and Torres Strait Islander women: clinical results immediate post and 3 months follow-up. BioMed Central Public Health 2012, 12:933.
• [31]Greene JC: Mixed methods in social inquiry. San Francisco, CA: Jossey-Bass; 2007.
• [32]Nelson A, Abbott R, Macdonald D: Indigenous Austalians and physical activity: using a social–ecological model to review the literature. Health Educ Res 2010, 25(3):498-509.
• [33]Willows ND, Hanley AJG, Delormier T: A socioecological framework to understand weight-related issues in Aboriginal children in Canada. Appl Physiol Nutr Metab 2012, 37(1):1-13.
• [34]Green LW, Kreuter MW: Health Promotion Planning: An educational and ecological approach. Third edition ed edition. Mayfield, Canada: Mountain View; 1999.
• [35]Miles MB, Huberman AM: Qualitative Data Analysis: An Expanded Sourcebook. Thousand Oaks, CA: Sage; 1994.
• [36]StataCorp: Stata statistical software: Release 11. Texas: Stata Corporation; 2009.
• [37]Attride-Stirling J: Thematic networks: an analytic tool for qualitative research. Qualitative Research 2001, 1(3):385-405.
• [38]Patton MQ: How to use qualitative methods in evaluation. Newsury Park, Canada: Sage Publications; 1987.
• [39]QSR International Pty Ltd: NVivo qualitative data analysis software, in Version 9. Australia: QSR International Pty Ltd; 2010.
• [40]Lasco RA, et al.: Participation rates, weight loss, and blood pressure changes among obese women in a nutrition-exercise program. Public Health Rep 1989, 104(6):640-646.
• [41]Baranowski T, et al.: A center-based progam for exercise change among Black-American families. Health Education Quartley 1990, 17(2):179-196.
• [42]Wilcox S, et al.: Perceptions of physical activity and personal barriers and enablers in African-American women. Ethn Dis 2002, 12(3):353-362.
• [43]Hunt J, Marshall AL, Jenkins D: Exploring the meaning of, the barriers to and potential strategies for promoting physical activity among urban Indigenous Australians. Health Promot J Austr 2008, 19(2):102-108.
• [44]Australian Bureau of Statistics: Australian Social Trends September 2010 The city and the bush. Indigenous wellbeing across remoteness areas 2010.
• [45]Dishman RK, Sallis JF, Orenstein DR: The determinants of physical activity and exercise. Public Health Rep 1985, 100(2):158-171.