Physical activity interventions among culturally and linguistically diverse populations: a systematic review

Barriers and enablers of women carers from culturally and linguistically diverse communities participating in physical activities

Introduction

This research article presents a phenomenological evaluation of an organization working within disability and with CALD communities of a project that was supporting women carers who are newly arrived to Australia to be happier and healthier. The initiative aimed to alleviate social isolation, enhance wellbeing, and boost confidence among women from Culturally and Linguistically Diverse (CALD) backgrounds in Metropolitan Melbourne, Victoria.

Methods

Through a qualitative exploration of the lived experiences of participants, findings were categorized into enablers and barriers, shedding light on the outcomes of physical activity participation for these women.

Results and discussion

Enablers included improvements in health, skill development, achievement, and enhanced social interaction and support, while barriers encompassed challenges related to access, socio-cultural factors, resource availability, interpersonal dynamics, and physiological constraints. Based on these findings, recommendations are proposed to empower CALD community members in the co-development and co-delivery of future programs, fostering sustainability and community-driven engagement.

Co-designing a Physical Activity Service for Refugees and Asylum Seekers Using an Experience-Based Co-design Framework

People from refugee and asylum seeker backgrounds resettling in Australia often experience intersecting risks for poor mental and physical health. Physical activity can promote better health outcomes, however there are limited programs tailored for this population. Therefore, understanding how to support refugees and asylum seekers to engage in physical activity is crucial. This paper aims to describe how the experience-based co-design (EBCD) process was used to identify priorities for a new physical activity service for refugees and asylum seekers. Using an EBCD framework we conducted qualitative interviews and co-design workshops with service users (refugees and asylum seekers living in the community) and service providers at a community Centre in Sydney, Australia. Sixteen participants, including eight service users and eight service providers engaged in the EBCD process over 12-months. The interviews revealed common themes or 'touchpoints' including barriers and enablers to physical activity participation such as access, safety and competing stressors. Subsequent co-design focus groups resulted in the establishment of five fundamental priorities and actionable strategies; ensuring cultural and psychological safety, promoting accessibility, facilitating support to access basic needs, enhancing physical activity literacy and fostering social connection. Using EBCD methodology, this study used the insights and lived experiences of both service users and providers to co-design a physical activity service for refugees and asylum seekers which is safe, supportive, social and accessible. The results of the implementation and evaluation of the program are ongoing.

A systematic review of culturally adapted physical activity interventions for culturally and linguistically diverse children and adolescents

OBJECTIVE

Limited evidence shows culturally and linguistically diverse (CALD) children and adolescents are less active, compared to the general population. It is unclear, how physical activity interventions have been adapted for CALD children and adolescents to enhance engagement. This study aimed to review culturally adapted physical activity interventions targeting CALD children and adolescents.

METHODS

All studies recruited children and adolescents (i.e., aged ≥5 to <18 years old) from CALD backgrounds, targeted physical activity, and included cultural adaptations. Cultural adaptations were defined as surface structures (i.e., observable characteristics of a targeted population) or deep structures (i.e., rooted in core ethnic values derived from individual cultures.

RESULTS

Twenty studies were included. Ten studies used a combination of surface and deep structure adaptations. Of these 10 studies, 3 found a significant between-group difference in physical activity favouring the intervention group. Among studies (n = 6) that used surface structure adaptations (e.g., language adjustments to information sheets, consent forms, and resources), 1 found a significant intervention effect on physical activity. With studies (n = 4) that used deep structure adaptations (e.g., incorporating traditional songs and dances relevant to cultural groups), 1 study found a significant intervention effect on physical activity.

CONCLUSION

A small number of studies found significant changes to increase physical activity levels. We found there is a lack of consistent evidence indicating that incorporating surface and/or deep structure adaptations result in significant changes in physical activity. Future research should focus on establishing higher quality methodology when developing culturally adapted interventions for CALD populations.

The Moderating Role of Collectivism on Physical Activity and Family Support: A Cross-Sectional Design

BACKGROUND

An important value among Korean Americans is collectivism or giving a group priority over the individual. This value, family support, and demographic characteristics have been reported to influence health behaviors among this group. Yet, no study has examined how collectivism, family support, and demographic characteristics interact with each other and then influence physical activity among Korean American adults. The purpose of the study was to examine the association between family support and physical activity, and the moderating role of demographic characteristics and collectivism on this association among Korean American adults.

METHODS

A descriptive, cross-sectional study was conducted with a sample of 110 Korean American adults 18 years and older, residing in a Southwestern city in the United States. Self-administered questionnaires were used to measure demographics, collectivism, family support, and physical activity.

RESULTS

Data analysis using a zero-inflated negative binomial regression model revealed a positive relationship between family support and physical activity, while age and gender were moderators of the relationship between family support and physical activity. Collectivism was positively related to physical activity and moderated the relationship between family support and physical activity.

CONCLUSION

These findings indicate the significance of collectivism and family support that influence Korean American adults' physical activity.

Examination of Physical Activity, Organized Sport, and Sitting Time Among Women and Mothers From Culturally and Linguistically Diverse Backgrounds

BACKGROUND

Little evidence is available from culturally and linguistically diverse (CALD) communities on the association between motherhood and physical activity (PA). This study aimed to examine independent and joint associations of cultural background and motherhood with meeting PA guidelines, participation in organized sports, and high sitting time (>8 h/d).

METHODS

We used self-reported cross-sectional data from survey 8 of the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health. PA was measured using the Active Australia Survey while organized sport and sitting time were measured using single items. CALD was defined as being born in a non-English speaking country or primarily speaking a non-English language at home. Multivariable-adjusted logistic regression analyses were used to examine independent and joint associations.

RESULTS

Data from 5967 women (mean age 42.4 [SD 1.5] y, 6.9% CALD, 81.2% mothers) were analyzed. Women of CALD background had lower odds of meeting PA guidelines (odds ratio; 95% confidence interval: 0.80; 0.64-0.98) and participation in organized sports (0.68; 0.54-0.86), but no statistically significant association with sitting time (0.90; 0.72-1.14). Mothers had lower odds of meeting PA guidelines (0.75; 0.64-0.87) and high sitting time (0.42; 0.36-0.49). Compared with non-CALD women without children, mothers (irrespective of cultural background) were less likely to meet PA guidelines and have high sitting time. The association of "cultural background and motherhood" with organized sports participation was only significant for CALD mothers.

CONCLUSIONS

Increased efforts and investments are needed to ensure that sports and other PA promotion interventions are culturally sensitive and engaging for CALD women and those with children.

Acceptability of Intergenerational Physical Activity Programming: A Mixed Methods Study of Latino Aging Adults in Nebraska

Objective: This study explored Hispanic/Latino aging adults' interest in and preferences for intergenerational physical activity programming. Methods: We used an exploratory sequential (Qual-QUAN) mixed methods design consisting of three focus groups (N = 13 participants; M age = 62.5 years old) and a quantitative survey (N = 105 participants; M age = 57.3 years old). Results: We found that most participants were interested in intergenerational physical activity programs: (1) to promote overall health and well-being, (2) increase opportunities for socialization and relationships, and (3) foster motivation and energy. Preferences for programming included cultural tailoring, bilingual and Spanish-language offerings, and being conducted in-person. Barriers to physical activity included cost, scheduling, transportation, and limited awareness of community resources. Discussion: Innovative public health initiatives incorporating an intergenerational approach may promote physical activity among aging adults. This study has implications for developing and refining intergenerational programming with Hispanic/Latino communities.

Physical activity amongst culturally and linguistically diverse communities in Australia: a scoping review

BACKGROUND

Australia's overseas-born population continues to grow. This population is disproportionately affected by chronic, non-communicable diseases. Physical activity is the cornerstone of all chronic disease management. Engaging people from culturally and linguistically diverse (CALD) backgrounds in physical activity is an important public health objective. The purpose of this scoping review was to examine the factors that shape physical activity participation among people from CALD backgrounds in Australia.

METHODS

This scoping review followed Arksey and O'Malley's framework. Medline, Embase and CINAHL were searched with key words relating to 'physical activity', 'CALD' and 'Australia' in July 2021 and again in February 2022 for qualitative studies published in English since 2000. Exclusion criteria were: participants < 18 years old, studies specifically focusing on populations with health issues, pregnant or postpartum states. Methodological quality of included studies was evaluated using the Critical Appraisal Skills Programme with the purpose of informing future research. Data extracted from each study were analysed thematically and results were interpreted using Acculturation theory.

RESULTS

Of the 1130 studies, 17 met the inclusion criteria. Findings from each study were captured in three themes: Perceptions of physical activity; Acceptability and Appropriateness; and Access. Following migration, a decrease in physical activity, especially leisure-time activity, was reported. Common factors influencing physical activity engagement included perceptions of physical activity and wellbeing; language, financial and environmental barriers; as well as social, cultural, and religious considerations.

CONCLUSION

This review identified several factors which may interact and contribute to the decline in self-reported physical activity upon migration. Findings from this review may be used to inform future health promotion initiatives targeting people from CALD backgrounds. Future research may benefit from devising a shared definition of physical activity and studying different CALD communities over time.

Recruitment and Retention Strategies for Underrepresented Populations and Adults With Arthritis in Behavioral Interventions: A Scoping Review

OBJECTIVE

To identify strategies used to recruit and retain underrepresented populations and populations with arthritis or fibromyalgia (FM) into behavioral programs targeting exercise, physical activity, or chronic disease self management.

METHODS

Five bibliographic databases were searched for articles published between January 2000 and May 2022. The search focused on strategies and best practices for recruiting and retaining underrepresented populations or populations with arthritis or FM into disease self-management or physical activity/exercise programs. Abstracts and full-text articles were screened for inclusion by 2 independent reviewers, and 2 reviewers extracted data from included articles.

RESULTS

Of the 2,800 articles, a total of 43 publications (31 interventions, 8 reviews, 4 qualitative/descriptive studies) met criteria and were included. The majority of studies focused on physical activity/exercise (n = 36) and targeted African American (n = 17), Hispanic (n = 9), or arthritis populations (n = 7). Recruitment strategies that were frequently used included having race- or community-matched team members, flyers and information sessions in areas frequented by the population, targeted emails/mailings, and word of mouth referrals. Retention strategies used included having race- or community-matched team members, incentives, being flexible, and facilitating attendance. Most studies used multiple recruitment and retention strategies.

CONCLUSION

This scoping review highlights the importance of a multifaceted recruitment and retention plan for underrepresented populations and populations with arthritis or FM in behavioral intervention programs targeting exercise, physical activity, or chronic disease self management. Additional research is needed to better understand the individual effects of different strategies and the costs associated with the various recruitment/retention methods in underrepresented populations and populations with arthritis.

'Football and dancing are in our blood': culture promoting sports practice among immigrants in Europe

The current state of knowledge indicates that regular sports practice helps prevent and treat non-communicable diseases. The promotion of sport is, therefore, an important community health intervention for maintaining and improving the health of individuals and populations. Culture is identified as being associated with sports practice and sedentary behaviour of ethnic and national minorities. This study aims qualitatively to analyse the potential for culture as a basis for the promotion of sport among immigrants in four regions of Mediterranean Europe. Ten focus groups (n = 62) were conducted with immigrants-adults and young people over the age of 11-and people involved in promoting sport. Thematic content analysis was conducted. The results enabled identifying two major issues: sport as a vehicle for cultural expression and synergies between sport and culture. Accordingly, sport serves to express global, local and non-ethno-national cultural belonging. Regarding synergies, culture and sport feed each other positively and contribute to immigrants' health and cultural well-being. Culture as a strategy for promoting sports practice requires an interdisciplinary approach that involves collaboration between healthcare practitioners and social sciences professionals. There is also a need to use the various axes of cultural definition-global, local and non-ethno-national-of those involved, and for them to take part themselves in designing sports activities. Moreover, promoting sport through non-ethno-national axes of cultural definition may help with immigrants' social inclusion, as intercultural relations between migrants and newcomers are promoted.

A Critical Review on New Approaches for Chronic Disease Prevention in Brazil and Canada: From Wholistic Dietary Guidelines to Physical Activity Security

In light of new evidence on the prevention of chronic diseases and the elevated rates of overweight and obesity in Brazil and Canada, this critical review aims to interpret and synthesize current aspects regarding dietary and physical activity initiatives in both countries and make future recommendations. The pioneering work presented in the last Brazilian dietary guidelines has been called a model that can be applied globally, given its conceptualization of healthy eating that translates easily to practical guidance. The new Canadian Food Guide has incorporated similar aspects, also putting the country as a leader in dietary guidance. With these new recommendations, citizens in both Brazil and Canada have access to impactful evidence-informed nutritional guidelines. Both documents propose eating patterns that focus not only on health benefits, such as chronic disease prevention, but also incorporate well-being concerning cultural, economic, sociodemographic, biological, and ecological dimensions. A similar approach is required for physical activity to allow individuals to have attainable health and life goals and thereby fully enjoy their lives, regardless of geographical location, health status, and socioeconomic condition, a concept recently described as physical activity security. The wholistic dietary guidelines from both countries represent a change in paradigm in public health. Likewise, national evidence-based policies are warranted to reduce disparities in physical activity, allowing healthier and more active lifestyles for everyone.

Evaluating psychosocial and physical activity outcomes following an intervention among Filipino Americans

Background: Physical activity (PA) is a strong contributor to enhancing a healthy lifestyle and preventing numerous chronic diseases. As ethnic minorities engage in low levels of PA, psychosocial and activity-based interventions for sustaining PA are crucial. Methods: The 6-month intervention incorporated culturally tailored educational workshops and weekly PA classes at a community center. Educational workshops were led by six trained community health workers (CHWs). Participants (n=37) completed pre- and post-intervention questionnaires regarding PA related self-efficacy, outcome expectations, social support, enjoyment, self-regulation, goal setting, and overall PA. Results: Following the intervention, study participants exhibited increases in weekly PA levels. Wilcoxon Signed-Rank test revealed higher median scores for Exercise Self-Efficacy Scale (ESES), Identified Regulation, and Intrinsic Motivation. Positive changes were observed for Physical Outcome Expectations, Social Outcome Expectations, Self-Evaluative Outcome Expectations, Physical Activity Enjoyment, Social Support for Exercise Scale - Family, Social Support for Exercise - Friends, and Exercise Goal-Setting. Conclusion: Community-based PA interventions may provide potential benefits to Filipino Americans, an ethnic Asian minority group, in identifying exercise benefits, developing proper exercise goals, increasing motivation, promoting PA behavior, and facilitating long-term PA adherence.

Feasibility and acceptability of a culturally tailored physical activity intervention for Arab-Australian women

BACKGROUND

Despite being one of the largest migrant groups in Australia, few physical activity interventions exist for Arab-Australians. The primary aim of this study was to test the feasibility and acceptability of a 12-week culturally tailored physical activity intervention for Arab-Australian women.

METHODS

This study used a single-group pretest-posttest design, and was informed by extensive formative research and consultation involving the Arab-Australian community. Participants were insufficiently active Arab-Australian women aged 35-64 with no current illness or injury that would limit physical activity participation. The intervention comprised 6 face-to-face physical activity and education sessions over 12 weeks. The intervention was conducted at 2 separate intervention sites in Western Sydney, Australia. Feasibility outcomes included recruitment, session attendance, and retention. The acceptability of the intervention was assessed through a process evaluation questionnaire completed post-intervention. Accelerometers and the short-form International Physical Activity Questionnaire were used to measure physical activity at baseline and post-intervention. Descriptive statistics were used for feasibility and acceptability outcomes, and changes in physical activity were examined using Wilcoxon signed-rank tests.

RESULTS

Of the 53 women who were contacted or expressed interest, 22 were eligible and enrolled in the study. Participants were primarily recruited through direct contact by Arab-Australian community workers and by word-of-mouth. Average session attendance was 63% and the retention rate post-intervention was 68%. The culturally-related intervention components, such as the appropriateness of content, and women-only setting, were rated highly favourably (4.33 to 4.87/5). General intervention elements, such as the face-to-face delivery, knowledge and approachability of facilitators, and session structure, were also rated favourably (4.33 to 4.93/5), and the lowest scored item was the intervention session frequency (3.2/5). There were no statistically significant changes in physical activity post-intervention.

CONCLUSIONS

The findings from this study highlighted factors related to recruitment and delivery that need to be considered when developing physical activity interventions for Arab-Australian women. Further research is required using a larger sample and a randomised controlled trial design to examine the longer-term impact on physical activity, and to also examine ways of increasing intervention engagement and retention among Arab-Australian women.

TRIAL REGISTRATION

ANZCTR, ACTRN12618001392257. Registered 20 August 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375636 .

Meanings and practices of the physical activity engaged in by Moroccan women in an Islamic urban environment: A quasi-ethnography

AIM

To understand the meanings and practices of the physical activity (PA) engaged in by Moroccan women in an Islamic urban environment.

DESIGN

Quasi-ethnographical study.

METHODS

13 semi-structured interviews and 15 observation sessions of the PA engaged in by women.

RESULTS

The concept of PA fits into the holistic approach of Islam. The social and cultural conditions of those who regularly practise PA are diverse. The community collaborates to overcome difficulties involved with this practice. The flexibility of issues such as gender segregation and clothing, Islam as a stimulus for PA, health as a value, the promotion of a rights and duty-based model for health care user, the community co-creation of the PA offer, and the power of organized civil society could inspire new strategies for the promotion of PA among Muslim women in other contexts.

Staying Strong Toolbox: Co-design of a physical activity and lifestyle program for Aboriginal families with Machado-Joseph disease in the Top End of Australia

Physical activity has positive health implications for individuals living with neurodegenerative diseases. The success of physical activity programs, particularly in culturally and linguistically diverse populations, is typically dependent on their alignment with the culture, lifestyle and environmental context of those involved. Aboriginal families living in remote communities in the Top End of Australia invited researchers to collaborate with them to co-design a physical activity and lifestyle program to keep individuals with Machado-Joseph disease (MJD) walking and moving around. The knowledge of Aboriginal families living with MJD, combined with findings from worldwide MJD research, formed the foundation for the co-design. An experience-based co-design (EBCD) approach, drawing from Indigenous and Participatory methodologies, was used. An expert panel of individuals with lived experience of MJD participated in a series of co-design phases. Prearranged and spontaneous co-design meetings were led by local community researchers within each phase. Data was collected using a culturally responsive ethnographic approach and analysed thematically. Sixteen panel members worked to develop the ‘Staying Strong Toolbox’ to cater for individuals with MJD who are ‘walking strong’; or ‘wobbly’; or ‘in a wheelchair’. Based on the ‘Staying Strong Framework’, the Toolbox was developed as a spiral bound A3 book designed to guide the user to select from a range of activities to keep them walking and moving around and to identify those activities most important to them to work on. The ‘Staying Strong Toolbox’ is a community driven, evidence based resource for a physical activity and lifestyle program for Aboriginal families with MJD. The Toolbox provides a guide for health professionals and support workers to deliver person-centred support to Aboriginal families with MJD, and that can be modified for use by other families with MJD or people with other forms of ataxia around the world.

A Tailored Web- and Text-Based Intervention to Increase Physical Activity for Latino Men: Protocol for a Randomized Controlled Feasibility Trial

Background

Latino men in the United States report low physical activity (PA) levels and related health conditions (eg, diabetes and obesity). Engaging in regular PA can reduce the risk of chronic diseases and yield many health benefits; however, there is a paucity of interventions developed exclusively for Latino men.

Objective

To address the need for culturally relevant PA interventions, this study aims to develop and evaluate Hombres Saludables, a 6-month theory-based, tailored web- and text message-based PA intervention in Spanish for Latino men. This protocol paper describes the study design, intervention, and evaluation methods for Hombres Saludables.

Methods

Latino men aged 18-65 years were randomized to either the individually tailored PA internet intervention arm or the nutrition and wellness internet control arm. The PA intervention included 2 check-in phone calls; automated SMS text messages; a pedometer; a 6-month gym membership; access to a private Facebook group; and an interactive website with PA tracking, goal setting, and individually tailored PA content. The primary outcomes were feasibility, acceptability, and efficacy (minutes per week of total moderate-to-vigorous PA assessed via the ActiGraph GT3X+ accelerometer worn at the waist and 7-day physical activity recall at baseline and 6 months). Secondary outcomes examined potential moderators (eg, demographics, acculturation, and environmental variables) and mediators (eg, self-efficacy and cognitive and behavioral processes of change) of treatment effects at 6 months post randomization.

Results

This study was funded in September 2016. Initial institutional review board approval was received in February 2017, and focus groups and intervention development were conducted from April 2017 to January 2018. Recruitment for the clinical trial was carried out from February 2018 to July 2019. Baseline data collection was carried out from February 2018 to October 2019, with a total of 43 participants randomized. Follow-up data were collected through April 2020. Data cleaning and analysis are ongoing.

Conclusions

We developed and tested protocols for a highly accessible, culturally and linguistically relevant, theory-driven PA intervention for Latino men. Hombres Saludables used an innovative, interactive, web- and text message–based intervention for improving PA among Latino men, an underserved population at risk of low PA and related chronic disease. If the intervention demonstrates feasibility, acceptability, and preliminary efficacy, we will refine and evaluate it in a larger randomized control trial.

Trial Registration

Clinicaltrials.gov: NCT03196570; https://clinicaltrials.gov/ct2/show/NCT03196570

International Registered Report Identifier (IRRID)

DERR1-10.2196/23690