Physical activity (PA) has been internationally recognised as a determinant of health and as a major modifiable lifestyle factor. It has been reported in previous literature that PA can play a vital role in the prevention and treatment of many non-communicable chronic diseases; with an inverse relationship existing between PA participation and all-cause mortality. Regardless of extensively published evidence on the health benefits that are derived from PA, levels of PA on a global scale remain low and are particularly low among those who have been classified as being socioeconomically disadvantaged. The reasons for this disparity and effective methods of intervention to increase levels of PA participation within these communities are not clear with previous research showing that health behaviour change is a complex process. Therefore, this thesis aims to acquire elucidation of effective methods of PA intervention and promotion in socio-economically disadvantaged communities.
Study one (see Chapter 3): This study aimed to review the effectiveness of PA interventions implemented in socio-economically disadvantaged communities and the theoretical frameworks and components used in these interventions. Five databases were searched (Jan 2000-Dec 2010) for papers that reported outcomes of PA interventions in socio-economically disadvantaged communities. Results showed that group-based interventions were effective for adults but not for children; evidence for interventions targeting individuals was insufficient; and limited evidence suggested that community-wide interventions produced small changes in PA. Interventions underpinned by a theoretical framework and including education, PA and social support were more likely to be effective. In conclusion, compared to other approaches, multi-component adult group-based interventions with theoretical frameworks are most effective in increasing PA in socioeconomically disadvantaged communities.
Study two (see Chapter 4): The aim of this study was to explore community leaders’ experiences of PA interventions in socio-economically disadvantaged communities; and to identify components associated with successful interventions and key components of the design and implementation of future interventions. A semi-structured interview approach was implemented to gain an insight into the interviewees’ (n = 12) opinions and experiences. Four themes emerged from the interview analysis: 1) Awareness of schemes; 2) Successful components; 3) Barriers for future PA interventions; and 4) Target groups. The study initiated the exploratory phase of the development of PA interventions for a socio-economically disadvantaged community; and suggested that better linkage and communication is required to promote PA, the local community should be involved from the outset and the intervention should be tailored to their wishes, planned strategically, with a specific timeline and funded fully. Finally, there was evidence of a bifurcation between those who think it best to concentrate effort on the socio-economically disadvantaged community as a whole, and those who think that effort needs to be targeted at specific subgroups in the population.
Study three (see Chapter 5): The objective of this study was to determine the demographic characteristics of individuals residing in a socio-economically disadvantaged community who require intervention to increase their levels of PA. A household survey was analysed (n = 1,209) which included an assessment of PA by the Global Physical Activity Questionnaire (GPAQ). Overall levels of PA appear adequate, although when sub-analysis was performed it showed that 38.4% (464/1209) had a low level of PA. Evidence highlighted that the demographic characteristics associated with low levels of PA in this socio-economically disadvantaged community were age, gender and employment status.
Study four (see Chapter 6): The aim of this study was to assess the validity and reliability of two subjective self-report PA measurement tools, GPAQ and the Sport and Physical Activity Survey (SAPAS) - by using an objective PA measurement tool (accelerometry); and to establish which method is most appropriate to: measure PA, monitor PA at the level of an individual, community or population; and measure change in PA following an intervention. A randomised study design was implemented stratified by gender and PA level. Results showed that the GPAQ had a moderate level of correlation (r = 0.48) with the objective tool whilst the SAPAS had a fair level of agreement (r = 0.36). With both self-report questionnaires showing no significant differences in minutes of MVPA per day when compared with accelerometry data (p >0.05). Overall the evidence highlighted that the GPAQ may be used to estimate levels of PA, monitor PA trends and assess the effectiveness of PA interventions on a community or population level. With the findings indicating that previously collected routinely available PA data within SARAS were acceptable when aiming to monitor the direction of trends in PA and to measure the extent of change post intervention at a community or population level.
In conclusion, it has been acknowledged that PA is a complex, multi-faceted lifestyle behaviour; with evidence highlighting that PA cannot be influenced and changed by intervening at one level but, rather, intervention has to be multi-dimensional with the implementation of a multi-factorial intervention package by a multi-disciplinary group of facilitators. Interventions should be ‘packages’ that are underpinned by a theoretical framework such as the Social Ecological Model and consist of components that are in line with this model.
|Date of Award
- Queen's University Belfast
|Margaret Cupples (Supervisor), Frank Kee (Supervisor), Mark Tully (Supervisor) & Ruth Hunter (Supervisor)