Motives and Barriers for Physical Activity among Low-Income Black Single Mothers

Factors influencing health-promoting behavior among single mothers in Northeastern Malaysia: a cross-sectional study

Introduction

Health-promoting behaviors (HPB) play a vital role in maintaining and enhancing overall well-being. Single mothers are at higher risk of cardiovascular disease (CVD) and less involvement in HPB due to psychosocial disadvantages.

Objective

This study aimed to determine the HPB scores and factors influencing HPB among single mothers in Kelantan (Northeastern, Malaysia).

Methods

This study employed a cross-sectional design, selecting 242 single mothers from Kelantan through proportional stratified sampling. Data were gathered through questionnaires covering sociodemographic details, the Health-Promoting Lifestyle Profile-II (HPLP-II), the Malay Version of Health Beliefs Related to Cardiovascular Disease (HBCVD-M), and Multidimensional Perceived Social Support (MPSS). The relationships between the dependent variable (HPB) and independent variables were analyzed using multivariable linear regression models.

Results

The respondents achieved an average HPB score of 118.03 (SD = 19.2), with the highest mean scores in spiritual growth (22.46 [SD = 3.70]) and interpersonal relationships (22.05 [SD = 3.67]). Physical activity had the lowest mean score at 15.09 (SD = 4.62). Significant positive associations were found between HPB and perceived severity of CVD (adjusted β = 1.60; 95% CI [0.68-2.53]; p < 0.001) as well as perceived social support (adjusted β = 0.63; 95% CI [0.37-0.90]; p < 0.001). Conversely, educational level (adjusted β = -10.36; 95% CI [-16.06 to -4.67]; p < 0.001) and perceived benefits of reducing CVD risk (adjusted β = -1.43; 95% CI [-2.37 to -0.48]; p < 0.001) were negatively associated with HPB.

Conclusions

The findings highlight the importance of health beliefs, social support, and education in shaping HPB among single mothers. Community health initiatives targeting this population should develop strategies to strengthen individuals' health beliefs and promote a supportive environment.

Household Composition, Income, and Fast-Food Consumption among Black Women and Men

Black adults are more likely to consume meals from fast-food restaurants than other racial/ethnic groups with implications for disparities in dietary quality and obesity outcomes. Family and economic characteristics are associated with fast-food consumption. The aim of this study was to determine the association between household composition, income, and fast-food consumption among Black women and men. A cross-sectional, secondary analysis of nationally representative data from the 2011-2018 National Health and Nutrition Examination Survey using multiplicative interaction terms and negative binomial regressions were used to assess whether household income moderated associations between number of children or older adults in the household and number of weekly fast-food meals consumed. Household composition was not associated with fast-food consumption among Black women overall. Yet, demonstrated by a significant interaction (incidence rate ratio (IRR) = 3.41, 95% confidence interval (CI) = 1.59-7.32), Black women with higher household income (≥ $75,000) and multiple young children consumed more fast-food compared to women with no children in the household. In contrast, Black men with one school-aged child in the home consumed fewer weekly fast-food meals than men with no school-aged children in the home (IRR = 0.69, 95% CI = 0.51-0.93). A significant interaction between number of older adults in the household and household income ≥ $75,000 (IRR = 3.56, 95% CI = 1.59-8.01) indicated that Black men with lower incomes and at least one older adult in the household consumed fewer weekly fast-food meals. These findings demonstrate that household composition and household income interact on fast-food consumption among Black women and men. Future studies should interrogate these differences, while programs and policies can be informed by the results of this study.

Contextual Factors Influencing the Adoption of Physical Activity Direct Education and Policy, Systems, and Environmental Change Initiatives by Virginia EFNEP and SNAP-Ed Staff

OBJECTIVE

To explore factors influencing the adoption of direct education programs and policy, systems, and environmental (PSE) change initiatives focused on physical activity for Supplemental Nutrition Assistance Program-eligible audiences by Virginia Expanded Food and Nutrition Education Program and Supplemental Nutrition Assistance Program-Education (SNAP-Ed) staff.

METHODS

Online survey with Expanded Food and Nutrition Education Program and SNAP-Ed peer (paraprofessional) educators (n = 28) and SNAP-Ed agents (master of science level) (n = 9) in Virginia. Descriptive statistics were computed for sociodemographic characteristics and responses to questions on the basis of Likert-type scales. Exploratory factor analyses were run to identify the underlying structures of the different variables.

RESULTS

The main factors for peer educators were related to substituting nutrition programs or content for physical activity programs. Other factors included staff qualifications and expectations about leading vs teaching physical activities. For PSEs, the top factors were the capacity to reach many community members, attract new partners and stakeholders, and personal interest in the PSE.

CONCLUSIONS AND IMPLICATIONS

The results provide insight into potential barriers and motivators for adopting physical activity education and PSEs within community-based initiatives and can be used to inform program planning and staff training. Additional research is warranted to examine other factors influencing the adoption and implementation of physical activity programs and PSEs.

A qualitative study of healthy eating, physical activity, and mental health among single mothers in Canada

Single motherhood is associated with higher demands in home and family responsibilities that may exist in similar sized households with grandparents. These demands can compete with opportunities and resources for maintenance of healthy behaviours. This may have been exacerbated during the COVID-19 pandemic since supports outside the home may have been restricted by public health measures. A qualitative narrative study was conducted to explore these issues with 12 single mothers in Canada. Semi-structured interviews provided an in-depth understanding of the challenges and facilitators to maintaining healthy eating habits, physical activity levels, and mental health. Theory-driven content and structural analysis were applied through a descriptive thematic approach. Challenges to maintaining healthy eating behaviours included stay-at-home orders, limited budget, unhealthy food/cravings, and lack of motivation. In contrast, living with grandparents who provide help or having an understanding of healthy food were factors that facilitated engagement in healthy eating. Challenges to maintaining physical activity levels included lack of willpower, lack of time, and low energy. Whereas time on one's own, weighing scales or outdoor gear, and weather conditions promoted physical activity. Spirituality and gratitude were the main coping mechanisms used to deal with loneliness, unemployment, and depressive symptoms. Further research into the utility of gratitude as a coping mechanism could inform public health interventions that aim to increase levels of well-being among single mothers.

Shouldering the load yet again: Black women's experiences of stress during COVID-19

Black women in the United States experience considerable amounts of stress, which has been exacerbated by the COVID-19 pandemic. Prior studies have linked stress to adverse mental and physical outcomes for Black women and, moreover, shown that Black women are more susceptible to maladaptive coping, which compounds these risks. Research on the Superwoman Schema and Sojourner's Syndrome, for instance, shows how Black women are compelled to portray strength and resilience while suffering internally and experiencing poor health outcomes. These phenomena can be attributed to the historical expectations of Black women to be pillars of their families and sources of strength despite adversity and persistent institutional discrimination. During the COVID-19 pandemic, Black women's greater likelihood of holding "essential worker" roles has further increased their risk of both COVID-19 exposure and heightened stress. Additionally, the COVID-19 pandemic has aggravated long standing structural inequities and disparities between Black women and other racial/ethnic groups. Drawing on journal entries submitted by Black women participating in the Pandemic Journaling Project (PJP), a combined online journaling platform and interdisciplinary research study, this paper illuminates the voices of Black women during the COVID-19 pandemic. Seventy-two Black women created journal entries using the PJP platform. We analyze the stories, idioms, and feelings they recorded during a global pandemic. We identify three prominent domains of stress: work and school, caregiving, and social (dis)connectedness. In addition to exploring manifestations of stress across these domains, we, discuss some of the mental health implications of COVID-19 and explore the potential for regular journaling as a possible mode of stress management among Black women.

Temporal stability of behavior, temporal cue-behavior associations, and physical activity habit strength among mothers with school-aged children

Objective: PA habits reflect stable, consistent patterns in behaviours that are performed automatically in response to temporal or contextual cues. Mothers face multiple demands and complex schedules related to parenting. This study examined how subject-level mean, variability, and slopes in device-measured moderate-to-vigorous physical activity (MVPA) over three different timescales were associated with mothers' PA habits. Methods and Measures: Mothers (n = 125; Mage=41.4 years) completed six measurement periods across three years. Each measurement period consisted of seven days of accelerometry. MVPA minutes were processed across hours, days, and measurement periods. PA habits were assessed in the last measurement period. Results: Subject-level means of MVPA at all timescales were positively associated with stronger PA habits (βs = 0.42-0.48, ps<.01). Subject-level variability in day-level MVPA was positively associated with habits (β = 0.39, p=.01). Furthermore, mothers who engaged in higher mean day-level MVPA had a more positive association between subject-level variability in day-level MVPA and habit strength compared to mothers with lower mean day-level MVPA overall (β = 0.28, p=.04). Mothers who had steeper increases in MVPA across measurement periods (i.e. subject-level slope) reported stronger habits (β = 0.43; p = 0.03). Conclusion: Flexibly adjusting daily PA levels may be a necessary strategy to maintain habits in the face of parenting demands.

The influence of clinic care on perceptions and knowledge of non-communicable diseases and physical activity from a low-resourced community: a mixed-method study

Background

Health promotion for the management of risk factors for non-communicable diseases (NCDs) is an integral part of standard care in South Africa. Most persons presenting with NCDs utilise public primary health care centres for disease management. This mixed-methods study aimed at expanding current understanding of the the influence of standard clinic care (usual care) on perceptions and knowledge of risk factors for NCDs and physical activity (PA) among persons from a low-resourced community. Qualitatively the perceptions of women from a low-resourced community about risk factors for NCDs and PA were explored throughout 24-weeks of standard clinic care. Parallel quantitative data was collected to describe changes in risk factors for NCDs and trends in self-reported knowledge about risk factors of NCDs and PA.

Method

A convergent-parallel mixed-methods research design was used. The study was carried out in a public primary health care setting, in the North West Province, South Africa. From a convenience sample of 100 participants, 77 African women aged between 34 and 79 years were recruited for the study. Data were collected at three time-points including baseline, 12 weeks, and 24 weeks of a standard clinic care health-promotion programme. The qualitative data was collected during focus group discussions, and the quantitative data included questionnaires on knowledge of physical activity and risk factors for NCDs as well as anthropometric and biological measurements. Qualitative and quantitative data were analysed independently for each phase and then consolidated for interpretation. All data was collected in the same setting.

Results

Participants' initial understanding and perceptions of NCD risk factors were poor. Qualitative findings showed that participants knew little about the specific physical activity they could engage in and the role of PA in NCD management. Participants preferred low-intensity activities. Heart-disease knowledge improved significantly at 12 weeks intervention compared to baseline MD = -3.655, p < 0.001. There were improvements in PA knowledge at 12 weeks from baseline MD = -0.625 p = 0.02. There were significant weight (MD = 1.420, p = 0.002) and waist circumference reductions (MD = 0.621, p = 0.02) from baseline to 24 weeks.

Conclusion

Standard clinic care improved knowledge of physical activity and risk factors for NCDs, but perceptions of risk factors for NCDs and PA were unchanged. This study offers insight into the perceptions held by women from a low-resource setting and how future interventions to manage and prevent NCDs should be structured.

Trial registration

PACTR201609001771813.

Interweaving Adult Fitness Classes Into Community Settings Via Stronger Austin's Community Partnership Model: Increasing Access to Physical Activity and Positive Social Connectedness in Underserved Communities

The lack of environmental supports for healthy lifestyles is a potent factor in the high prevalence of noncommunicable diseases among communities experiencing economic disadvantage. Stronger Austin aimed to increase access to free physical activity (PA) and fitness programming (eg, Zumba) in underserved communities in Austin, Texas, via a partnership and interweaving into context approach in which classes are interwoven into settings with widespread access for residents, including clinics, city-supported housing, parks, recreation centers, and schools. We aimed to better understand the PA-related benefits and opportunities for improvement when adult fitness classes are interwoven into community settings. A mixed-methods design guided the study, which included SOFIT (Structured Observation of Fitness Instruction Time) assessments of class PA (n = 160 participants) and qualitative assessment of highlights and recommendations for class improvement via participant focus groups (n = 24), open-ended questionnaires (n = 258), and instructor interviews (n = 6). Findings indicated high levels of class PA (76.9%-86.9% of 1-hour class spent in moderate-to-vigorous PA; mean of 18 participants per class), with positive social connectedness cited as a key benefit. Challenges and best practices of community-based fitness classes are explored. Stronger Austin's partnership and interweaving into context approach represents a promising model for increasing access to fitness classes in underserved communities.

Environmental Factors Associated with Physical Activity in Rural U.S. Counties

Background: Rural U.S. adults’ prevalence of meeting physical activity (PA) guidelines is lower than urban adults, yet rural-urban differences in environmental influences of adults’ PA are largely unknown. The study’s objective was to identify rural-urban variations in environmental factors associated with the prevalence of adults meeting PA guidelines. Methods: County-level data for non-frontier counties (n = 2697) were used. A five-category rurality variable was created using the percentage of a county’s population living in a rural area. Factor scores from Factor Analyses (FA) were used in subsequent Multiple Linear Regression (MLR) analyses stratified by rurality to identify associations between environmental factor scores and the prevalence of males and females meeting PA guidelines. Results: FA revealed a 13-variable, four-factor structure of natural, social, recreation, and transportation environments. MLR revealed that natural, social, and recreation environments were associated with PA for males and females, with variation by sex for social environment. The natural environment was associated with PA in all but urban counties; the recreation environment was associated with PA in the urban counties and the two most rural counties. Conclusions: Variations across the rural-urban continuum in environmental factors associated with adults’ PA, highlight the uniqueness of rural PA and the need to further study what succeeds in creating active rural places.

Household Composition, Income, and Body Mass Index Among Adults by Race/Ethnicity and Sex

OBJECTIVE

Disparities in obesity highlight the need for an examination of determinants that may be uniquely experienced by race and sex. An understudied factor is household composition with the potential for variation in its obesogenic impacts. This study examines the association between household composition and body mass index (BMI) among Black, Hispanic, and White adults and determines whether income moderates these associations.

METHODS

Using cross-sectional data from the 2011-2018 National Health and Nutrition Examination Survey, the number of children and adults aged ≥ 60 years in the household were reported among non-Hispanic Black and White adults as well as Hispanic adults aged 20-59 years old. Multivariable linear regressions were used to assess the associations between household composition and BMI with income as a potential moderator.

RESULTS

Having multiple school-aged children was associated with higher BMI (β = 1.34, standard error (s.e.) = 0.50) among Hispanic men, while having older adults in the household was associated with lower BMI among Black women (β = - 3.21, s.e. = 1.42). Income moderated the associations between household composition and BMI among Black women and men. There were no associations between household composition and BMI in White women or men.

CONCLUSIONS

Future studies should further explicate the mechanisms of household composition that uniquely impact obesity outcomes among Black women and men by income. Efforts to address higher BMI among those with more young children in the household should target Hispanic men.

Operationalization of intersectionality in physical activity and sport research: A systematic scoping review

Participation in and opportunities for physical activity (PA) and sports (PA inclusively hereafter) are known to vary across individuals with different social positions. Intersectionality theory may help us to better understand the complex processes of multiple interlocking systems of oppression and privilege shaped by intersections of individuals’ social categories. The objectives of this systematic scoping review were (1) to summarize the findings of articles examining PA claimed operationalization of intersectionality and (2) to identify the scope and gaps pertaining to the operationalization of intersectionality in PA research. A search was conducted in September 2019 in seven electronic databases (e.g., SPORTDiscus, Scopus, Web of Science) for relevant research articles written in English. Key search terms included “intersectionality” AND “physical activity” OR “sport”. Database searches, data screening and extraction, and narrative synthesis were conducted between September 2019 and May 2020. Of 16564 articles identified, 45 articles were included in this review. The majority of included articles used qualitative methods (n = 41), with two quantitative and two mixed-methods articles. The most frequently observed intersectional social position was sex/gender + race/ethnicity (n = 11), followed by sex/gender + race/ethnicity + sexuality (n = 6) and sex/gender + race/ethnicity + religion (n = 6). Most qualitative studies (n = 38) explicitly claimed operationalization of intersectionality as a key theoretical framework, and over half of these studies (n = 27) implicitly used intra-categorical intersectionality. Two quantitative studies were identified which examined a number of intersections simultaneously using inter-categorical intersectionality. Complex processes of individual and social-structural level factors that drive inequalities in PA opportunities and participation could be better elucidated with the operationalization of intersectionality theory. Intersectionality theory may serve as a useful framework in both qualitative and quantitative investigations. Advancement in quantitative intersectionality is critical in order to produce knowledge that could inform more inclusive PA promotion efforts.

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Intra-categorical intersectionality is commonly used in most qualitative investigations.

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Inter-categorical intersectionality is used in quantitative research.

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Utilizing multiplicative statistical models may advance quantitative intersectionality.

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Investigating varying axes of marginalization beyond sex/gender + race/ethnicity is important.

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Intersectionality is useful in better understanding disparities in physical activity.

Ethnic Disparities in Social Capital and Health among Jewish and Arab Participants in the Israeli Mamanet Cachibol League

The Israeli Mamanet Cachibol League (MCL) serves as a community model that incorporates physical activity and amateur team sports among women. Team sports have been shown to bridge gaps and build positive relationships between communities. There is a paucity of data regarding the advantages of team sports to promote the health and well-being of women from different ethnic backgrounds. The purpose of this study was to examine the association of participation in MCL with social capital, health, and well-being across two ethnic groups: Jewish and Arab women. A cross-sectional survey was conducted among women aged 25–64: 102 Jewish and 96 Arab MCL participants, and 102 Jewish and 81 Arab non-MCL participants. Data regarding social capital (trust, social support and social involvement) and well-being (self-reported health and psychosomatic and depressive symptoms) were analyzed using two-way analyses of covariance and multiple regression models with sequential entry of the variables. MCL participants from both ethnic groups reported higher social capital (p < 0.001), better self-reported health (p < 0.001), and lower psychosomatic symptoms (p < 0.001) compared to non-participants. Jewish MCL participants reported lower depressive symptoms (p < 0.001) than non-participants, however no difference was found between Arab MCL participants and non-participants (p < 0.160). Amateur team sports such as MCL are related with higher levels of well-being and social capital. Future research should focus on longitudinal studies that examine the change in social capital and well-being over time.

Social ecological factors associated with physical activity and screen time amongst mothers from disadvantaged neighbourhoods over three years

BACKGROUND

Mothers from socioeconomically disadvantaged neighbourhoods are at elevated risk of physical inactivity and high levels of screen time. Yet, little is known regarding the social ecological factors that are longitudinally associated with physical activity and screen time in this target group, and whether the age of their children impacts these relationships. This study aimed to longitudinally examine the social ecological factors associated with physical activity and screen time amongst mothers living in socioeconomically disadvantaged neighbourhoods, and whether these differed according to their child's age.

METHODS

Data were from 895 mothers living in socioeconomically disadvantaged neighbourhoods (mean age 36.7 years) at baseline and three-year follow-up. Mothers self-reported weekly discretionary physical activity (leisure-time, LTPA; transport-related, TRPA) and screen time durations. Linear regression models assessed associations between five intrapersonal, three social and five physical environmental factors and LTPA, TRPA and screen time, adjusting for confounding factors, clustering by neighbourhood and baseline variables. Interaction analysis was conducted for age of children (younger and older children (n = 442) and mothers with older children (aged 5-12 years) only (n = 453).

RESULTS

In adjusted models, all intrapersonal factors (self-efficacy, enjoyment, outcome expectations, behavioural intentions and behavioural skill), social support from friends, neighbourhood cohesion and number of televisions were longitudinally associated with LTPA amongst all mothers. Interaction models showed that findings were generally consistent across groups (i.e., those with both younger and older children compared to those with older children only), with three exceptions. Physical activity enjoyment and social support from family were associated with LTPA only among mothers with older children. Neighbourhood cohesion was associated with screen time only amongst mothers with both younger and older children. No associations were detected for TRPA.

CONCLUSION

Intrapersonal, social and physical environmental factors were longitudinally associated with mother's LTPA, whilst neighbourhood cohesion was longitudinally associated with screen time behaviours amongst mothers. Interventions aimed at increasing LTPA amongst mothers (particularly those from socioeconomically disadvantaged neighbourhoods) may need to target all domains of the social ecological model and may require some tailoring according to the age of children. Further work is needed to identify longitudinal associations with screen time and TRPA in this population group.

Correlates of Physical Activity Among Disadvantaged Groups: A Systematic Review

CONTEXT

Socioeconomically disadvantaged adults have lower engagement in leisure-time physical activity than those who are more affluent. Identification of correlates of physical activity can inform the design of effective interventions. The aim of this systematic review was to identify consistent correlates of unspecified physical activity and leisure-time physical activity among socioeconomically disadvantaged adults.

EVIDENCE ACQUISITION

PubMed and Scopus were searched up to May 2018, and titles/abstracts and full texts were screened against eligibility criteria. Methodologic quality was assessed, and correlates were synthesized from July to September 2018.

EVIDENCE SYNTHESIS

Seventy-three studies were selected for synthesis; 48 examined unspecified physical activity and 31 examined leisure-time physical activity (6 examined both). Self-rated health, functional capacity, and physical activity self-efficacy were consistently, positively associated with unspecified physical activity. Mental health status and perceived benefits and enjoyment of physical activity were consistently, positively associated with leisure-time physical activity. Most studies were cross-sectional and used validated self-report measures of physical activity; few reported response rates >50%.

CONCLUSIONS

Few factors were consistently associated with either unspecified physical activity or leisure-time physical activity. Based on available evidence, strategies to increase physical activity should consider the needs of, and focus on, those with poor self-rated health and functional capacity and should use strategies to improve physical activity self-efficacy. Strategies to increase leisure-time physical activity should focus on simultaneously addressing leisure-time physical activity and mental health concerns and improving perceptions of physical activity benefits and enjoyment. It is recommended that future studies focus on leisure-time physical activity, focus on men, use longitudinal design, examine variables related to behavioral attributes and skills, and carefully consider and plan recruitment strategies.

Impact of a standard versus collective-efficacy enhanced intervention to increase physical activity among mothers

Objective: Mothers have lower moderate-to-vigorous physical activity than non-mothers and this negatively impacts health. Group dynamics interventions have been successful for increasing physical activity, yet studies using these strategies among mothers are limited and rely on self-reported physical activity. The goal of this study was to examine the effectiveness of a collective-efficacy enhanced physical activity intervention that used group dynamics principles compared to a standard group-based intervention. Design: Mothers (N = 86) were randomly assigned to a 6-week intervention (collective-efficacy enhanced) or standard health education/walking group. Main outcome measures: participants wore pedometers for 1-week and completed a self-efficacy questionnaire at pre-intervention, post-intervention, and 3-month follow-up. Results: There were statistically significant increases in activity minutes (p = 0.05) and step counts (p = 0.049) and no changes in self-efficacy (p = 0.74) from pre- to post-intervention. There were no group by time interactions for changes in physical activity or self-efficacy. None of the changes in physical activity were maintained at follow-up. Conclusions: There is a continued need to understand how to use social factors to promote sustained physical activity among mothers.

Goals Matter: Exercising for Well-Being But Not Health or Appearance Predicts Future Exercise Among Parents

BACKGROUND

Many parents are insufficiently active. Further research is needed to understand the goals that drive sustained exercise participation among parents. The purpose of this study was to use self-determination theory derived constructs to examine the relationship between parents' exercise goals and their autonomous motivation, controlled motivation, and exercise behavior across 1 year.

METHODS

Mothers (n = 226) and fathers (n = 70) of children less than 16 years completed the Exercise Motivations Inventory-2 and, 1 year later, the Behavioral Regulation in Exercise Questionnaire-2 and Godin Leisure-Time Exercise Questionnaire. Linear mixed effects models were used to examine the longitudinal relationships between exercise goals and autonomous motivation, controlled motivation, and leisure-time exercise.

RESULTS

All goals except weight management were significantly associated with autonomous motivation, whereas only weight and appearance goals predicted controlled motivation. Exercising for stress management and revitalization, but not health- or appearance-related goals, was significantly related to exercise behavior over 1 year.

CONCLUSIONS

Only goals related to immediate affective outcomes were associated with both autonomous motivation and exercise behavior over time. These findings support recent calls to "rebrand exercise" as a means to improve daily well-being. Such goals may drive parents to prioritize exercise because they value the immediate benefits it provides.