ReviewWhat are the barriers and facilitators to exercise and physical activity uptake and adherence among South Asian older adults: A systematic review of qualitative studies
Highlights
► Poor English language proficiency is a barrier to obtaining accurate information. ► Relatives can be important in motivating/facilitating older adults to be active. ► Generating group norms may produce positive benefits to changing PA behaviour.
Introduction
As populations across the globe are ageing (United Nations, 2002), keeping active can be a means of preventing disease or attenuating a condition's progress when onset has occurred (DH (Department of Health), 2009a, WHO, 2008), limiting healthcare resource use and preserving quality-of-life as a consequence. Those reaching retirement may be a key age group to target with PA interventions (Berger et al., 2005) given that this is a life-stage when individuals have more leisure-time. But older people may not see the benefits of PA for them and/or be unaware of opportunities for keeping active (Myers, 1999). They can also regard ‘slowing down’ as a natural part of ageing and, therefore, be unmotivated to exercise (Tierney et al., 2011a). This may partly explain the high percentage of inactive older adults (WHO, 2009). In England, only 19% of 65–74 year-olds and 6% of people aged 75 + meet recommended targets of at least 150-minutes of moderate intensity activity over a week (NHS Information Centre, 2008). Levels are even lower for minority ethnic groups (NHS Information Centre, 2006).
Sedentary behaviour is common among South Asians (SAs) compared to their white European peers (Hayes et al., 2002, Yates et al., 2010). For example, data from the Health Survey for England found they were 60% less likely than Caucasians to meet government recommendations for PA (Williams et al., 2011). Likewise, a systematic review by Fischbacher et al. (2004) examined PA levels among SAs compared to the general UK population and noted that rates were 50–75% less for the former. These authors comment on the lack of objective measures of PA used within included studies, which tended to be assessed via self-report questionnaires. Nevertheless, it does seem that PA is low among SAs, a group experiencing greater rates of coronary heart disease (CHD), stroke and type-2 diabetes (Bhopal, 2002, Gill et al., 2007, Hayes et al., 2002, Yates et al., 2010). Therefore, encouraging PA in SA communities remains a public health priority.
Healthcare professionals could play a role in promoting PA at every opportunity when interacting with patients, but this requires an understanding of how individuals experience recommendations to be active. We know that culture and ethnicity influence health and behaviour (Gill et al., 2007, Gupta, 2010). Given SAs increased risk of vascular problems and tendency to be sedentary, it is important to ensure that interventions are culturally sensitive by understanding experiences of the target population.
A synthesis of qualitative studies has become an important means of informing health-related policy and practice so that the needs and preferences of patients remain central to any discussion about treatments and/or service redesign (Facey et al., 2010, Ring et al., 2011). Moreover, there is an increasing recognition that qualitative studies can contribute to and enhance decision-making by presenting data on issues not explained by quantitative studies, thereby complementing traditional systematic review methods (Flemming, 2007, Noyes et al., 2008).
The purpose of a qualitative synthesis is to produce larger interpretive representations of studies examined (Barroso et al., 2003). We were interested in exploring the experiences of SA older adults reported in published papers to try and understand why they may or may not undertake PA to inform future development of interventions. This type of information is best collected using qualitative research as quantitative methods do not allow for an in-depth consideration of barriers and enablers that are important to participants.
No qualitative systematic reviews have focussed on psychological, social and organisational factors influencing uptake and maintenance of PA among SA older adults (≥ 60 years). We felt an older age group may have particular concerns not experienced by younger individuals that may be important to contemplate when developing interventions. The synthesis aimed to identify:
- 1.
beliefs regarding uptake of and adherence to PA;
- 2.
culturally appropriate approaches to increase uptake and adherence to PA;
- 3.
inter, intra, community and organisational factors influencing PA.
Section snippets
Search strategy and selection criteria
The following databases were searched for the literature published between January 2000 and October 2011: BNI, CINAHL, EMBASE, Medline, PsycINFO and SPORTSDiscus. We used terms relating to age, ethnicity, PA and qualitative methods (Box 1). We tried to be as inclusive as possible with initial searches to avoid overlooking relevant studies. Bibliographies of identified papers were examined for additional references. Primary inclusion criteria were qualitative research with a SA sample (first,
Results
From 535 references identified via databases, 11 papers, reporting on 10 separate studies, were included (Fig. 1), key characteristics of which are outlined in Table 1. Quality scores (out of 28) ranged from 20 to 25. Investigations were conducted in Canada and the UK. Participants included SA men and women with the following conditions who were advised to undertake PA to improve their health: CHD (Bedi et al., 2008, Darr et al., 2008, Galdas et al., 2011, King et al., 2006, Webster et al., 2002
Themes
After reading included papers on several occasions, charting data and examining these charts, several figures were produced to explain the data derived from studies. This resulted in the overarching conceptual framework of empowering and disempowering contexts influencing activity levels among this population group. It was felt that this best incorporated all data, providing a useful and accessible means of depicting the synthesised papers. Empowering and disempowering contexts were located
Discussion
This synthesis of qualitative studies has identified four themes influencing PA among SA adults, each contributing to the overarching concept of disempowering and empowering contexts. It is acknowledged that several of the issues raised in reviewed papers could apply to a generic population. For example, perceived inability to be active due to ageing is not unique to SA older adults (Tierney et al., 2011b). However, factors were recognised within the synthesis specific to SA older adults (Box 2
Conclusion
Synthesising qualitative data relating to people's views and experiences can assist in guiding the development of interventions to increase PA. The review suggested that practitioners should provide an advice based on an understanding of the potential barriers and enablers experienced by SA older adults. Developing collectivist approaches to promote external motivation may prove helpful. Support from family, friends and community groups, appears to enable these older adults to become active and
Conflict of interest statement
The authors declare there is no conflict of interest.
References (61)
- et al.
Older immigrant Sikh men's perspective of the challenges of managing coronary heart disease risk
J. Ment Health
(2008) - et al.
Causal attributions, lifestyle change and coronary heart disease: illness beliefs of patients of South Asian and European origin living in the United Kingdom
Heart Lung
(2008) - et al.
The influence of primary health care professionals in encouraging exercise and physical activity uptake among White and South Asian older adults: experiences of ‘young’ older adults
Patient Educ. Couns.
(2010) - et al.
What influences physical activity in people with heart failure? A qualitative study
Int. J. Nurs. Stud.
(2011) - et al.
Levels of physical activity and relationship with markers of diabetes and cardiovascular disease risk in 5474 white European and South Asian adults screened for type 2 diabetes
Prev. Med.
(2010) Self-Efficacy: The Exercise of Control
(1997)- et al.
The challenges of searching for and retrieving qualitative studies
West. J. Nurs. Res.
(2003) - et al.
Experiences of outreach workers in promoting smoking cessation to Bangladeshi and Pakistani men: longitudinal qualitative evaluation
BMC Publ. Health
(2011) - et al.
The impart of retirement on physical activity
Ageing Soc.
(2005) Epidemic of cardiovascular disease in South Asians
Br. Med. J.
(2002)
Coronary Heart Disease: National Service Framework
Be Active Be Healthy: A Plan for Getting the Nation Moving
Putting Prevention First — NHS Health Check: Vascular Risk Assessment and Management Best Practice Guidance
Increasing physical activity: a quantitative synthesis
Med. Sci. Sports Exerc.
Recruiting South Asians to a lifestyle intervention trial: experiences and lessons from PODOSA (Prevention of Diabetes & Obesity in South Asians)
Trials
Patients' perspectives in health technology assessment: a route to robust evidence and fair deliberation
Int. J. Technol. Assess. Health Care
How physically active are south Asians in the United Kingdom? A literature review
J. Public Health
The relationship between religious identity and preferred coping strategies: an examination of the relative Importance of interpersonal and intrapersonal coping in Muslim and Christian Faiths
Rev. Gen. Psychol.
The synthesis of qualitative research and evidence-based nursing
Evid. Based Nurs.
Qualitative studies using in-depth interviews with older people from multiple language groups: methodological systematic review
J. Adv. Nurs.
Canadian Punjabi Sikh men's experiences of lifestyle changes following myocardial infarction: cultural connections
Ethn. Health
Health care needs assessment of Black and minority ethnic groups
Impact of culture on healthcare seeking behaviour of Asian Indians
J. Cult. Divers.
Patterns of physical activity and relationship with risk markers for cardiovascular disease and diabetes in Indian, Pakistani, Bangladeshi and European adults in a UK population
J. Public Health Med.
What do community-dwelling Caucasian and South Asian 60–70 year olds think about exercise for fall prevention?
Age Ageing
Health Survey for England 2004: The Health of Minority Ethnic Groups
Health Survey for England Adult Trend Tables 2007
Effect of the self-monitoring approach on exercise maintenance during cardiac rehabilitation: a randomized, controlled trial
Am. J. Phys. Med. Rehabil.
Reviewers Manual
Gender-based challenges faced by older Sikh women as immigrants: recognizing and acting on the risk of coronary artery disease
Can. J. Nurs. Res.
Cited by (86)
Pain experiences of Hindi-speaking Indian migrants in Sydney: a qualitative study
2022, Physiotherapy (United Kingdom)Citation Excerpt :One of the strongest cultural values to emerge was collectivism. This is consistent with previous reports among Indian populations for chronic back pain [11,18], and other chronic health conditions that show involvement of the community in intervention planning and delivery makes the intervention more acceptable and effective [35,36]. Similar findings of collectivist values have been observed in other CALD migrant communities in Australia [37].
Promoting adherence to organised physical activity among socially disadvantaged older people
2021, Ageing and SocietyIdentifying the Health Concerns of Pregnant British Pakistani Women Living in Deprived Areas: A Qualitative Study
2024, Maternal and Child Health JournalThe Role of Facilitators in the Constraint Negotiation of Leisure-Time Physical Activity
2024, Leisure Sciences