Development and evaluation of a physical activity intervention informed by participatory research- a feasibility study

'I've just heard that there are people who feel like they need to exercise': a photo-elicitation study of values and priorities influencing physical activity in a socioeconomically disadvantaged neighbourhood in Uppsala, Sweden

OBJECTIVE

People living in socioeconomically disadvantaged neighbourhoods in Sweden engage less in physical activity compared with the general population, contributing to an elevated risk of cardiometabolic diseases. To inform targeted and effective public health interventions, understanding residents' lived experiences is essential. This study sought to understand the values and priorities associated with physical activity by people living in a socioeconomically disadvantaged neighbourhood in Region Uppsala, Sweden, informing a public health intervention to prevent cardiometabolic diseases and promote healthy and active living.

DESIGN

The study employed a photo-elicitation methodology, combining participants' photographs with semistructured interviews. Data were analysed using reflexive thematic analysis.

SETTING

A socioeconomically disadvantaged neighbourhood in the city of Uppsala, Sweden, characterised by a large proportion of households with low income, a large percentage of individuals living on economic aid, high unemployment rates, low educational attainment and high levels of poor health.

PARTICIPANTS

A total of 15 participants (8 women and 7 men) were purposively sampled between February and August 2023 and recruited via fieldwork, social media and local stakeholders.

RESULTS

Participants described challenging conditions for physical activity, including conflicting values and priorities between themselves and the local authorities. Four main areas emerged as sources of tension; difficulties influencing decision-making processes affecting the neighbourhood, unmet needs of gender-separated physical activity spaces, discrepancy between the perceived pressure and individual motivation to be active, and their perception of health being solely an individualised responsibility, but their need of support.

CONCLUSIONS

This study underscores the importance of understanding and navigating the values and priorities influencing physical activity among residents in a socioeconomically disadvantaged neighbourhood, when designing public health interventions. Findings reveal that residents' needs for being physically active are not met by the authorities who are perceived to have different priorities, and that the lack of influence of citizen voices undermines trust in the local authorities.

Design, implementation and evaluation of an intervention based on a social cognitive theory of physical activity and nutritional behaviors in middle-aged people at the risk of coronary artery disease in Bandar Abbas: A study protocol

BACKGROUND

Coronary artery disease (CAD) is the most common cardiovascular disease (CVD) and the main cause of mortality in developed and developing countries. Physical activity and nutritional behaviors are modifiable factors in people at the risk of CAD and its risk factors; thus, the present study aimed to design, implement, and evaluate an intervention based on the social cognitive theory for physical activity and nutritional behaviors in the middle-aged population at the risk of CAD residing in Bandar Abbas city.

MATERIALS AND METHODS

The present study will be conducted in three phases: qualitative, cross-sectional, and community-based intervention. The middle-aged population with less than 150 minutes of physical activity a week with at least one other risk factor of CAD (hyperlipidemia, hypertension, diabetes, overweight and obesity, smoking) will be included in the study. In the qualitative phase of study, the participants will be selected with maximum diversity and with the aim of obtaining comprehensive information to clarify the nature and dimensions of the phenomenon in question. The cross-sectional phase aimed to determine the intensity of physical activity and nutritional behaviors. By analyzing the data obtained from the cross-sectional phase, the most important constructs of the social-cognitive theory in physical activity and nutritional behaviors will be determined, and accordingly, an effective intervention will be designed. The third phase of the pre-test-post-test intervention study will include a randomized control group. The interventions will be a combination of face-to-face meetings and the use of educational technologies. Individuals in the control group will not undergo the educational intervention. Those in the intervention group will be evaluated in two phases (before the implementation of the intervention, and 3 months after the intervention).

CONCLUSION

The findings of the present study can be used as a strategic plan to help policy makers to strengthen CVD prevention and management alternatives to include physical activity and nutritional behavior as part of their preventive measures.

Health and quality of life among women after participation in a CBPR-informed physical activity intervention: with a pandemic perspective

The lack of culturally and contextually oriented interventions promoting physical activity (PA) has led to increased physical inactivity among women living in disadvantaged neighbourhoods in Sweden. In this study one such intervention informed by community-based participatory research (CBPR) has been evaluated among 34 women from a disadvantaged neighbourhood before and during COVID-19. Health-related quality of life (HRQOL), behavioural and biomedical outcomes were assessed directly prior and post-intervention, followed by evaluations at 6-months and 18-months follow-up during COVID-19. The results revealed that HRQOL, particularly psychological, social, and environmental health significantly increased post-intervention compared to prior to intervention but reversed back at 6-months follow-up. Perceived health satisfaction and environmental health increased at 18-months follow-up during COVID-19. Participation in PA improved post-intervention and at 6-months follow-up. Everyday activities and fruit and vegetable intake continued to increase through all timepoints. Systolic blood pressure significantly decreased post-intervention and 6-months follow-up; blood flow rate increased significantly at all timepoints. Overall, the findings underscores the potential effectiveness of CBPR approaches in promoting and sustaining healthy lifestyles, even during acute situations such as the COVID-19. It may even serve as a future model for promoting health and addressing health disparities in similar groups.

Psychometric properties of the WHOQOL-BREF in citizens from a disadvantaged neighborhood in Southern Sweden

Background

Citizens living in disadvantaged neighborhoods experience poorer health than the majority, and this inequality is a public health problem even in a welfare state such as Sweden. Numerous initiatives aimed at improving health and quality of life in these populations are being implemented and evaluated. Given that these populations are predominantly multicultural and multilingual, an instrument such as the WHOQOL-BREF, which is cross-culturally validated and available in multiple languages, may be appropriate. However, this cannot be ascertained since the psychometric properties of WHOQOL-BREF have never been assessed in the Swedish context. Thus, the current study aimed at assessing the psychometric properties of the WHOQOL-BREF questionnaire in citizens from a disadvantaged neighborhood in Southern Sweden.

Methods

The respondents in this study were 103 citizens who participated in the health promotional activities of a Health promotional program and also responded to the 26-item, WHOQOL-BREF questionnaire as a part of an evaluation to assess the impact of the activities on the health-related quality of life of citizens. A Rasch model using WINSTEP 4.5.1 was used to assess the psychometric properties in this study.

Results

Five of the 26 items, including pain and discomfort, dependence on medical substances, physical environment, social support, and negative feelings did not display acceptable goodness-of-fit to the Rasch model. On removing these items, the 21-item WHOQOL-BREF scale had an improved internal scale validity and person-separation reliability than the original 26-item version for this group of citizens from the neighborhood. When assessing the individual domains, three of the five items that were misfits on analyzing the full model also showed misfits in relation to two respective domains. When these items were removed, the internal scale validity of the domains also improved.

Conclusion

WHOQOL-BREF seemed to be psychometrically inadequate when used in the original form due to internal scale validity problems, while the modified 21-item scale seemed better at measuring the health-related quality of life of citizens living in socially disadvantaged neighborhoods in Sweden. Omission of items shall be done but with caution. Alternatively, future studies may also consider rephrasing the items with misfits and further testing the instrument with larger samples exploring the associations between subsamples and specific item misfit responses.

Impact of a CBPR-informed physical activity intervention before and during COVID-19 among women from a disadvantaged neighborhood in Sweden

Background

Public health practitioners have been striving to reduce the social gradient and promote physical activity among citizens living in disadvantaged neighborhoods. The emergence of the COVID-19 pandemic, which has affected these citizens extensively, has posed a significant challenge to efforts to maintain a physically active lifestyle. Thus, the aim of this study was to explore the impact of a CBPR-informed physical activity intervention before and during the COVID-19 pandemic from the perspective of women from a socially disadvantaged neighborhood.

Methods

A total of 34 women participated in a CBPR-informed physical activity intervention previously developed in collaboration with lay health promoters and other citizens from the same neighborhood. Focus group discussions were conducted at four time points, namely, at baseline prior to the intervention, post-intervention, 6 months after the intervention ended, and during the COVID-19 pandemic. The data were analyzed using qualitative content analysis following an inductive approach.

Results

In total, four themes emerged from the discussions: "Wavering between frustration and action," "Shifting from prioritizing family needs to taking control of self," "Between isolation and social support," and "Restricted access to health-related knowledge vs. utilizing internalized knowledge".

Conclusion

The results of this study reveal that building on CBPR-informed health promotion initiatives has the potential to foster individual empowerment and assist during acute situations like the COVID-19 pandemic through mobilizing communities and their resources, which leads to increased community resilience and health. This study is regarded as unique in that it involves evaluation of a CBPR intervention that was initiated ahead of the pandemic and followed even during the pandemic.

Lay Health Promoters Empower Neighbourhoods-Results From a Community-Based Research Programme in Southern Sweden

This article focuses on the role of lay health promoters in the Lindängen initiative, a community-based participatory research (CBPR) programme for health promotion that started 2016 in a low-income neighbourhood in the outskirts of Malmö, southern Sweden. The programme aimed to support equitable health and develop an innovative model for community health promotion. The purpose of this article is to describe the role of the lay health promoters in the initiative and discuss the challenges of their position mediating between residents of the neighbourhood and the established institutions, using interviews, meeting notes and focus groups sessions with the health promoters and local stakeholders. Lay health promoters' role and function developed in a collaborative process of networking with local stakeholders and citizens in local meeting places. Their work was based on their credibility in their role, in combination with the use of a CBPR model that was open to innovation, with a strong focus on actively engaging members of the community. This allowed the lay health promoters to take political and social stances towards various issues, and to start to concretely address the social determinants of health in the community, as well as express recommendations to policymakers. Based on these experiences, the lay health promoters gained clearer insights into the institutional and structural conditions that impact their community. The position they had in the process of the programme resulted in empowerment and a new local association for health promotion; LindängenKraft (LindängenPower) driven by the health promotors and community members.

The Need for Parental Support for Migrant Parents in Transition Into Sweden: A Perspective

Migration is a stressful experience and research shows that newly arrived migrants in Sweden suffer from different challenges and struggle to relate to parenting in a new culture that is different from their own. The Swedish Child Health Services (CHS) focuses on promoting health among children, as well as supporting parents in parenting. Although this is a goal, migrant parents participate at lower rates in parental support groups. This paper aims to discuss how the Swedish CHS can support these families and address the need for improvement in the parental support offered to migrant parents during transition into their host country. In addition, this paper also aims to review and discuss the advantages of using a community-based participatory research approach together with the Swedish CHS to identify and apply culturally appropriate support programs to increase health literacy among migrant parents. The Swedish government decided to place greater emphasis and resources on supporting parents and promoting equal health among families in Sweden, with special emphasis on migrants and other vulnerable groups. This report from the Swedish government indicates the importance of creating knowledge about new ways, methods, and actions that may be needed to increase this support. One suggestion of this paper is to provide culturally appropriate healthcare work using a community-based participatory research approach, where migrant parents themselves are actively involved in the development of support programs. This approach will not only provide migrant families knowledge and support, it will also build on their needs and the challenges they can share, and receive support to overcome.

Office workers' perspectives on physical activity and sedentary behaviour: a qualitative study

Background

Office workers spend a significant part of their workday sitting. Interventions that aim to reduce sedentary behaviour and increase physical activity might be more effective if greater attention is paid to individual perspectives that influence behavioural choices, including beliefs and values. This study aimed to gain insight into office workers' perspectives on physical activity and sedentary behaviour.

Methods

Sixteen Dutch office workers (50% female) from different professions participated in semi-structured face-to-face interviews in March 2019. To facilitate the interviews, participants received a sensitizing booklet one week before the interview. The booklet aimed to trigger them to reflect on their physical activity and sedentary behaviour and on their values in life. All interviews were audiotaped, transcribed verbatim and coded following codebook thematic analysis.

Results

Six themes were identified: 1) beliefs about health effects are specific regarding physical activity, but superficial regarding sedentary behaviour; 2) in addition to ‘health’ as a value, other values are also given priority; 3) motivations to engage in physical activity mainly stem from prioritizing the value ‘health’, reflected by a desire to both achieve positive short/mid-term outcomes and to prevent long-term negative outcomes; 4) attitudes towards physical inactivity and sedentary behaviour are diverse and depend on individual values and previous experiences; 5) perceived barriers depend on internal and external factors; 6) supporting factors are related to support and information in the social and physical environment.

Conclusions

The great value that office workers attach to health is reflected in their motivations and attitudes regarding physical activity. Increasing office workers' knowledge of the health risks of prolonged sitting may therefore increase their motivation to sit less. Although ‘health’ is considered important, other values, including social and work-related values, are sometimes prioritized. We conclude that interventions that aim to reduce sedentary behaviour and increase physical activity among office workers could be improved by informing about health effects of sedentary behaviour and short/mid-term benefits of physical activity, including mental health benefits. Moreover, interventions could frame physical activity as congruent with values and support value-congruent choices. Finally, the work environment could support physical activity and interruption of sedentary behaviour.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13024-z.

Empowering communities with health promotion labs: result from a CBPR programme in Malmö, Sweden

Health promotion is thus not only a participatory practice, but a practice for empowerment and social justice. The study describes findings from a community-based participatory and challenge-driven research program. that aimed to improve health through health promotion platform in an ethnically diverse low-income neighbourhood of Malmö, Sweden. Local residents together with lay health promoters living in the area were actively involved in the planning phase and decided on the structure and content of the program. Academic, public sector and commercial actors were involved, as well as NGOs and residents. Empowerment was used as a lens to analyse focus group interviews with participants (n=322) in six co-creative health-promoting labs on three occasions in the period 2017-2019. The CBPR interview guide focused on the dimensions of participation, collaboration and experience of the activities. The CBPR approach driven by community member contributed to empowerment processes within the health promotion labs: Health promotors building trust in social places for integration, Participants motivate each other by social support and Participants acting for community health in wider circle. CBPR Health promotion program should be followed up longitudielly with community participants to be able to see the processes of change and empowerment on the community level.

Developing and evaluating non-invasive healthcare technologies for a group of female participants from a socioeconomically disadvantaged area

When compared to the general population, socioeconomically disadvantaged communities frequently experience compromised health. Monitoring the divide is challenging since standardized biomedical tests are linguistically and culturally inappropriate. The aim of this study was to develop and test a unique mobile biomedical testbed based on non-invasive analysis, as well as to explore the relationships between the objective health measures and subjective health outcomes, as evaluated with the World Health Organization Quality of Life survey. The testbed was evaluated in a socioeconomically disadvantaged neighborhood in Malmö, which has been listed as one of the twelve most vulnerable districts in Sweden. The study revealed that compared to conventional protocols the less intrusive biomedical approach was highly appreciated by the participants. Surprisingly, the collected biomedical data illustrated that the apparent health of the participants from the ethnically diverse low-income neighborhood was comparable to the general Swedish population. Statistically significant correlations between perceived health and biomedical data were disclosed, even though the dependences found were complex, and recognition of the manifest complexity needs to be included in further research. Our results validate the potential of non-invasive technologies in combination with advanced statistical analysis, especially when combined with linguistically and culturally appropriate healthcare methodologies, allowing participants to appreciate the significance of the different parameters to evaluate and monitor aspects of health.

Development, implementation and evaluation of the 'BELIEVE' program for improving physical activity among women: a mixed method action research study

Background

There is insufficient physical activity among women. Yet the implementation of effective, multilevel, and evidence-based interventions may address this. Since the lifestyle of individuals is formed in many different social, physical and cultural contexts, it will be necessary in designing such interventions to involve many stakeholders. Consequently, the present study took a mixed method action research approach in developing, implementing and evaluating a bespoke program to improve physical activity among women.

Methods

This study was conducted within the Khoramroudi neighborhood of Tehran between 2013 and 2015 utilizing the four main phases of action research. The Mobilizing for Action through Planning and Partnerships (MAPP) process was used to design the study. During the initial phase, participants were organized into three groups; a core support committee, a steering committee, and a study population. Qualitative and quantitative data were also collected during this first phase. During the second phase, interventions were developed and implemented. In the third phase, an evaluation was carried out using both quantitative (Designing a quasi-experimental study) and qualitative methods. During the fourth phase, an exploration of the structure and process of action research was completed with the aim of providing a conceptual model and descriptions of the context.

Results

Three strategic interventions were effective in improving physical activity among women: (1) utilization of sports assistants; (2) Local health promotion and the dissemination of an informational, motivational and culturally competent booklet entitled “Educational content for sport assistants" (3) Group-based cognitive behavioral therapy. Quantitative results [Significant difference between the total score of PA before the intervention, and 1 and 3 months after the intervention (P < 0.001)] and the results of qualitative evaluations were shown to improve physical activity among participants. The newly co-created “adjusted MAPP model” was offered within three action cycles. The structure of this was described to capture the impacts of interactions among a variety of stakeholders.

Conclusion

The comprehensive identification of problems led to the development of collaborative strategies. Strategies of action research can positively affect physical activity among women. To improve physical activity outcomes more generally, the use of MAPP principles and strategies is suggested to meet the specific needs and strengths of all community members.

"It was just for us": qualitative evaluation of an exercise intervention for African-American couples

Background

Promoting long-term exercise adherence should be a key focus for health and fitness professionals working to reduce obesity and cardiometabolic health disparities, and all-cause mortality in inactive African-American (AA) adults. Data have suggested that romantic partners can improve long-term exercise adherence and that this dyadic approach should be examined in exercise interventions. Therefore, the purpose of this study was to conduct a qualitative evaluation of a pilot exercise intervention conducted in older AA couples.

Methods

Two semi-structured focus groups were utilized to compare participants’ perceptions of and experiences during the pilot intervention across two randomly assigned treatment conditions (exercising together with partner [ET; n = 8] versus exercising separately [ES: n = 6]). Participants (mean age: 64.7 ± 6.8 years) of a previous 12-week pilot exercise intervention (walking ≥3 days/week, 30 min/day plus supervised resistance training 2 days/week) were interviewed. Verbatim transcripts were coded using an open coding approach.

Results

Three key themes (intervention value/benefits, intervention difficulties, and suggested improvements) emerged. Although all couples identified health and relationship benefits of the intervention, some differences surfaced within themes across the two intervention groups.

Conclusions

Overall, these qualitative data suggest that couples had a positive experience while participating in the pilot study. In addition, key learning points to improve the intervention were identified including a more gradual transition to independent exercise, more flexibility training, and the incorporation of tangential education. These data will help investigators continue to develop the intervention, which is ultimately designed to promote long-term exercise adherence to reduce cardiometabolic health disparities in the AA community.

Collaborating in a penta-helix structure within a community based participatory research programme: 'Wrestling with hierarchies and getting caught in isolated downpipes'

BACKGROUND

In the light of the existence of social inequalities in health, a CBPR (Community Based Participatory Research) programme for health promotion started in Malmö, Sweden, in 2017. The programme was based on a penta-helix structure and involved a strategic steering group with representatives from academia, voluntary organisations, the business sector, the public sector, and citizens from the community where the programme took place. The aim of this study was to explore how the penta-helix collaboration worked from the perspectives of all partners, including the citizens.

METHODS

Individual interviews, that were based on a guide for self-reflection and evaluation of CBPR partnerships, were conducted with the representatives (N = 13) on three occasions, during the period 2017-2019. A qualitative content analysis was used to analyse the interviews.

RESULTS

Six themes emerged from the analysis, including Challenges for the partners in the penta-helix collaboration; Challenges for the professionals at the local level; Citizen-driven processes are important for the penta-helix collaboration; Health promoters are essential to build trust between different sectors of society; Shift of power; and System changes take time. The analysis shows that the penta-helix collaboration worked well at the local level in a governance-related model for penta-helix cooperation. In the overall cooperation it was the citizen-driven processes that made the programme work. However, the findings also indicated an inflexibility in organisations with hierarchical structures that created barriers for citizen involvement in the penta-helix collaboration.

CONCLUSION

The main issue uncovered in this study is the problem of vertically organised institutions where discovery and innovation processes flow down from the top, thereby eliminating the essential input of the people and community that they are supposed to serve. The success of the programme was based on an interprofessional cooperation at a local level, where local professions worked together with voluntary organisations, social workers, CBPR researchers from the university, citizens and local health promoters.

Determinants of Physical Activity Engagement in Patients With Nonalcoholic Fatty Liver Disease: The Need for an Individualized Approach to Lifestyle Interventions

OBJECTIVES

Physical activity (PA) is an important non-pharmacological treatment for non-alcoholic fatty liver disease (NAFLD). This study investigated the determinants of PA engagement and awareness of the World Health Organization (WHO) PA guidelines in patients with NAFLD.

METHODS

Study participants were 101 patients with NAFLD (median age: 54 [IQR = 15] y; 53 men and 48 women) who completed 4 questionnaires: (1) a PA guideline awareness questionnaire; (2) a PA questionnaire assessing PA levels; and (3) 2 questionnaires assessing perceived barriers and motivators for engaging in PA. Binary logistic regression was performed to assess predictors of PA levels.

RESULTS

Twenty-four percent of participants correctly identified the recommended WHO weekly PA guidelines, and 39% adhered to the guidelines. Lack of willpower, time, and energy were the most frequently cited barrier domains. Scores for lack of willpower (odds ratio [OR] = 1.445, 95% CI = 1.088-1.919) and lack of resources (OR = 1.378, 95% CI = 1.003-1.893), and reporting 3 or more "significant" barrier domains (OR = 5.348, 95% CI = 1.792-15.873) were significant predictors of PA levels. Maintaining health and fitness was the most cited motivator domain and was a significant predictor (OR = 2.551, 95% CI = 1.253-5.208) of PA levels.

CONCLUSIONS

This study highlights the lack of awareness of the WHO PA guidelines and the key determinants of PA participation in patients with NAFLD. Determinants of PA should be identified at the individual level to create a personalized approach for PA maintenance for people with NAFLD to promote lifelong participation in PA.

IMPACT

This study closes a gap in the published data on the determinants of PA engagement in patients with NAFLD.

LAY SUMMARY

Physical inactivity is the fourth leading cause of global mortality and contributes to many chronic inflammatory diseases, including obesity, type 2 diabetes, cardiovascular disease, and nonalcoholic fatty liver disease (NAFLD). People with NAFLD engage in less physical activity compared with people who are healthy, and this study provides new information that clinicians can use to help these patients increase their physical activity participation.