A model for promoting physical activity among rural South African adolescent girls

Facilitators and barriers to physical activity among English adolescents in secondary schools: a mixed method study

Background

It is evident that physical activity (PA) programmes implemented in schools were not effective in improving PA behaviours among adolescents. This study investigated students' perceptions of barriers to PA among inactive English adolescents in secondary schools based on the Capability, Opportunity, Motivation, and Behaviour (COM-B) model, the Behaviour Change Wheel (BCW), and Theoretical Domains Framework (TDF). The study compared barriers faced by inactive and active groups participating in sports and PA in secondary schools to identify sources of behaviour contributing to inactivity.

Methods

A pre-intervention online survey was distributed to affiliated schools by 233 Teaching Schools Alliances (TSAs) as part of the monitoring and evaluation of the Secondary Teacher Training study. Data were cross-tabulated to analyse activity levels and behavioural barriers for active and inactive groups, using the COM-B domains. The research team followed a seven-step process to categorise barriers based on their relevant domain in the TDF mapped to the COM-B.

Results

The findings were derived from one of the most extensive surveys of adolescents ever undertaken involving 200,623 active and 8,231 inactive respondents. The study identified 52 barriers and 68 behaviours that prevent adolescents from participating in PA. Psychological and social barriers were found to affect all activity levels, genders, and ethnic groups, with a lack of confidence and self-consciousness being the most prevalent. Certain demographic groups, such as those from minority ethnic groups and disabled individuals, were found to be overrepresented among inactive populations. The finding of the study indicated that there were common barriers that affected both inactive and active groups, with further similarity when examining barriers between active and inactive girls. The study also found that girls were more likely to experience the main barriers compared to boys, while inactive boys were more likely to encounter these barriers compared to active boys. The findings suggest that common barriers could be addressed across the population, while recognising some differences in demographics, and the need to provide personalised support. Targeted interventions are also suggested for all girls and inactive boys.

Conclusion

This study highlights the range of barriers that impact adolescents and provides insight into potential mechanisms for behaviour change, including intervention functions, policy categories, and evidence-based behaviour change tools. The study highlights the need for further research to address the barriers to PA among adolescents, particularly those who are inactive. Utilising the findings of this study, future research should investigate the effectiveness of novel digital exercise interventions and policies in increasing PA levels among children and adolescents. Complex digital exercise interventions, including conversational AI solutions, could provide personalised tools to identify and revolutionise support around the multitude of barriers that impact adolescents globally."For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission."

Barriers and facilitators of physical activity among school attending adolescents in Lagos State, Nigeria: A qualitative study exploring views and experiences of decision-makers in secondary schools

Background and Aims

Schools represent a unique setting for promoting lifelong physical activity during critical development stages of life. Opportunities for in-school physical activity largely depend upon school-level policies, practices, and administrative support. A significant information gap exists on the factors influencing adolescents' participation in school-based physical activity programs in Nigeria. This study aimed to identify and explore the barriers and facilitators of physical activity in school-attending adolescents in Lagos State, Nigeria.

Methods

A qualitative study, using semistructured interviews, was conducted to explore the views and experiences of 21 decision-makers who were responsible for planning the physical and health education curriculum in secondary schools in Lagos State, Nigeria. Data were analyzed using the thematic analysis framework.

Results

Eight themes were identified and explored. The barriers were (i) students' characteristics, (ii) parental objections, (iii) no prioritization of physical activity, (iv) insufficient resources, and (v) challenges with schools' initiatives. The facilitators were (vi) students' interests, (vii) students' awareness of benefits, and (viii) schools' initiatives.

Conclusion

Our study findings can help in designing interventions to increase physical activity among school-attending adolescents in Lagos, Nigeria.

Benefits and barriers to physical activity among African women: A systematic review

Black women have always been likened to being a less physically active group compared to women of other races/ethnicity, with reports of a high prevalence of obesity and other cardiometabolic diseases among them. The purpose of this study is to examine the health benefits of physical activity on women of color, as well as barriers that inhibit their participation. We searched PubMed and Web of Science databases for relevant research articles. Included articles were: Published in the English Language from 2011 to February 2022; conducted predominantly on black women, African women, or African American women. Articles were identified, screened, and data extracted following the Preferred Reporting Item for Systematic Review and Meta-Analysis (PRISMA) guidelines. The electronic search produced 2 043 articles, and 33 articles were reviewed after meeting the inclusion criteria. 13 articles focused on the benefits of physical activity while 20 articles addressed the barriers to physical activity. It was found that physical activity has various benefits for black women participants but they are being hindered from participation by some factors. These factors were grouped into four themes, namely Individual/Intrapersonal barriers, Socio-economic barriers, Social barriers, and Environmental barriers. Various studies have examined the benefits and barriers of physical activity among women of different racial and ethnic backgrounds, but there have been very few studies of African women, with the majority focusing on one geographical area. In addition to exploring these benefits and barriers, this review offers recommendations on the areas researchers should focus on to promote physical activity in this population.

The Barriers to and Facilitators of Physical Activity and Sport for Oceania with Non-European, Non-Asian (ONENA) Ancestry Children and Adolescents: A Mixed Studies Systematic Review

BACKGROUND

Participation in sport and physical activity (PA) leads to better overall health, increased life expectancy, and decreased mortality rates across the lifespan; however, there may be a range of individual, family, and community factors that influence PA participation among ONENA children and adolescents residing in the 22 Pacific Island Countries and Territories (PICT) and Australia. This review aimed to synthesise existing quantitative and qualitative literature regarding barriers to and facilitators of PA and sport among ONENA youth.

METHODS

The literature was systematically searched to include studies reporting barriers to and facilitators of PA and sports participation among ONENA children and adolescents aged 0-18 years residing in the 22 PICT and Australia. Using a pre-established taxonomy based on the social-ecological model, a deductive analysis was performed. Quality appraisal was performed using the mixed methods appraisal tool.

RESULTS

Of 1388 articles, 14 studies were included, with 128 ONENA children and adolescent participants across the four qualitative studies; 156,581 ONENA children and adolescents across the seven quantitative studies; 801 parents, children, and adolescents in one quantitative study; and 642 parents in two quantitative studies. Of the 14 included studies, none were based in Australia and only 10 of the 22 PICT were reported as the participants' residence: Palau, New Zealand, Tonga, Cook Islands, Kiribati, Samoa, Solomon Islands, Tuvalu, Vanuatu, and Fiji. Four studies reported barriers, and another four studies reported facilitators of PA and sport, with the remaining studies reporting both barriers and facilitators. Overall, there were more barriers reported (30 in total) than facilitators (27 in total).

CONCLUSIONS

Research in this area is lacking, with ONENA youth living in Australia and 12 PICT not represented. Overall, there were a larger number of facilitators experienced at individual and interpersonal levels, while barriers were highest at the community level, with the policy level having facilitators and barriers equally represented. Programs that offer PA and sport participation options with embedded SDT-informed strategies for all family members; that are accessible through existing transport and related social, cultural, and physical infrastructure; and that are committed to communities through formal co-design partnerships are needed, to enhance the PA and sport participation of ONENA youth residing in PICT.

Associação entre sedentarismo e nível socioeconômico em adolescentes

Introdução: O sedentarismo em adolescentes contribui para a ocorrência de diferentes doenças, sendo relevante investigar sobre fatores associados. Objetivo: Analisar a associação entre sedentarismo e nível socioeconômico em adolescentes de escolas públicas. Materiais e métodos: Estudo transversal, realizado com 347 adolescentes matriculados em escolas públicas do ensino médio do município de Divinópolis, Minas Gerais. A coleta de dados ocorreu no ano de 2017. O sedentarismo foi avaliado utilizando-se o International Physical Activity Questionnaire e o nível socioeconômico pelo critério da Associação Brasileira de Empresas de Pesquisa. Foi realizada estatística descritiva e analítica através de modelo de regressão logística multivariada. Resultados: Participaram da investigação 347 adolescentes. A média de idade do grupo foi de 16,4 ± 1,0 anos. Os indivíduos caracterizados como sedentários constituíram 38,9% da amostra, sendo que, destes, 66,7% eram do sexo feminino. Possuir maior nível socioeconômico diminui a probabilidade de ser sedentário (OR=0,235; p=0,021), assim como ser estudante das escolas públicas da região sudoeste aumenta essa chance (OR=2,680; p=0,04). Discussão: Os motivos pelos quais as condições socioeconômicas podem influenciar o sedentarismo são variados. A ausência de espaços públicos pode contribuir para a elevação do sedentarismo em adolescentes com menor nível socioeconômico. Conclusão: Esta investigação sinaliza a importância de investimentos públicos em políticas de estímulo à prática de atividade física para os adolescentes, em especial para os do sexo feminino e de menor nível socioeconômico.

Population-level interventions targeting risk factors of diabetes and hypertension in South Africa: a document review

BACKGROUND

South Africa bears an increasing burden of non-communicable diseases (NCDs), particularly diabetes, cardiovascular diseases, and cancer. The objective of this study was to identify which population-level interventions, implemented at the level of governmental or political jurisdictions only, targeting risk factors of diabetes and hypertension were included in policies in South Africa. We also looked at whether these have been implemented or not.

METHODS

A review of relevant reports, journal articles, and policy documents was conducted. Documentation from government reports that contains information regarding the planning, implementation and evaluation of population-level interventions targeting diabetes and hypertension were considered, and various databases were searched. The identified population-level interventions were categorized as supportive policies, supportive programs and enabling environments according to the major risk factors of NCDs i.e., tobacco use, harmful consumption of alcohol, unhealthy diet/nutrition and physical inactivity, in accordance with the WHO 'Best buys'. A content document analysis was conducted.

RESULTS

The source documents reviewed included Acts and laws, regulations, policy documents, strategic plans, case studies, government reports and editorials. South Africa has a plethora of policies and regulations targeting major risk factors for diabetes and hypertension implemented in line with WHO 'Best buys' since 1990. A total of 28 policies, legislations, strategic plans, and regulations were identified - 8 on tobacco use; 7 on harmful consumption of alcohol; 8 on unhealthy diet and 5 on physical inactivity - as well as 12 case studies, government reports and editorials. There is good progress in policy formulation in line with the 'Best buys'. However, there are some gaps in the implementation of these policies and programs.

CONCLUSION

Curbing the rising burden of NCDs requires comprehensive strategies which include population-level interventions targeting risk factors for diabetes and hypertension and effective implementation with robust evaluation to identify successes and ways to overcome challenges.

Exploring the diet and physical activity behaviours of adolescents living in India and sub-Saharan Africa: a qualitative evidence synthesis

OBJECTIVE

To carry out a qualitative evidence synthesis to explore what influences the diet and physical activity of adolescents living in five countries that constitute the Transforming Adolescent Lives through Nutrition (TALENT) consortium (Cote D'Ivoire, Ethiopia, India, South Africa and The Gambia).

DESIGN

A search of electronic databases was conducted for qualitative articles published between 2000 and 2019.

PARTICIPANTS

Studies that explore influences on the diets and physical activity habits of adolescents aged 10-19 years.

RESULTS

Of the twelve included studies, none were identified from The Gambia or Cote D'Ivoire. The existing qualitative literature focussed on three major areas in relation to adolescents' diet and physical activity: (1) the influence of body image and self-esteem; (2) social and environmental influences and (3) poverty. The limited existing literature focusses heavily on girls' experiences particularly in relation to body image and dysfunctional eating practices.

CONCLUSIONS

In-depth research exploring adolescents' perceptions of diet and physical activity is needed to better understand how both boys and girls, at different stages of adolescence, perceive health, diet and physical activity. More research with young people is required especially in countries where little exists to cover a wider range of issues that play a role in diet and physical activity.

Adolescents' Perspectives on the Barriers and Facilitators of Physical Activity: An Updated Systematic Review of Qualitative Studies

Listening to adolescents' voices has been important to promote meaningful physical activity (PA) opportunities. Therefore, an updated systematic review of the available qualitative literature on adolescents' perspectives on the barriers and facilitators of PA was conducted, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies published between 2014 (date of the last systematic review) and 2020 were searched in the Web of Science, EBSCO, and SCOPUS databases. Based on the inclusion criteria applied, 30 out of 8069 studies were included in the review. A thematic analysis was used to inductively and deductively analyze the perspectives of ~1250 adolescents (13-18 years). The studies took place in 13 countries from different continents. The main PA barriers and facilitators of PA were presented and discussed around five higher-order themes: (1) Individual factors (e.g., psychological-motivation, self-efficacy; cognitive-knowledge, understanding; physical-motor skills); (2) social and relational factors (family, friends, significant others); (3) PA nature factors (fun, school-based PA and physical education); (4) life factors (time and competing activities; life-course); and (5) sociocultural and environmental factors (e.g., availability/access to PA facilities, programs; urban/rural zones). By transnationally framing adolescents' voices, this study provides updated evidence and discusses innovative implications for developing tailored interventions and pedagogical strategies aimed at promoting active and healthy lifestyles.

Factors influencing obesogenic behaviours of adolescent girls and women in low- and middle-income countries: A qualitative evidence synthesis

This systematic review synthesized the qualitative evidence on factors influencing obesogenic behaviours in adolescent girls and women of reproductive age in low- and middle-income countries (LMICs). This qualitative evidence synthesis followed the framework synthesis approach to extract, analyse and synthesize data. Electronic searches were conducted in the Web of Science, SCOPUS, CABI Abstracts, MEDLINE, PsycINFO and Google Scholar. Studies were eligible if they were conducted in LMICs, of qualitative nature, and reported obesogenic behaviours of female adolescents (10-19 years of age) or women of reproductive age (15-49 years of age). The review resulted in 71 included studies from 27 different countries. Thirty-two studies focused on dietary behaviours, 17 on physical activity and 22 on both behaviours. Gender norms and failures to recognize the importance of healthy behaviours across the life cycle were important factors. The abundance and promotion of affordable but unhealthy food, food safety concerns, taste preferences and social desirability of foods drive consumption of unhealthy foods. Busy lives and limited exercise spaces keep girls and women from being physically active. Obesogenic behaviours of adolescent girls and women of reproductive age are influenced by factors at individual, social, physical and environmental levels and require diverse solutions to address these factors in LMICs.

Physical Activity Measured by Accelerometry in Mozambican Older Adult Women Attending a Regular Exercise Program

Time spent in different Physical Activity (PA) Intensities of 72 Mozambican older adult women (67 ± 7 years old) was assessed by means of triaxial accelerometers for 7 consecutive days, and participants were stratified based on their body mass index, as being normal weight (NW, n = 23); overweight (n = 16); or obese (OB, n = 33). Overall, most daily time was spent in sedentary activities (614 ± 111 min or 69.1%) and light PA (181 ± 56 min or 20.2%). On average, moderate to vigorous PA (MVPA) was performed during 10.6% of the day (93 ± 44 min). Time spent in MVPA was significantly higher in the NW compared to OB category (112.8 ± 51.5 vs. 81.0 ± 36.3; p = .021). The overweight group did not differ in time spent in MVPA when compared to NW and OB group. Overall, 75% of the participants spent more than 60 min a day in MVPA (NW: 83%; overweight: 81%; OB: 67%). Pearson's correlation between body mass index and total MVPA controlling for age was -.39 (p < .001). It was concluded that Mozambican older adult women living in urban and rural areas of Maputo province engaged in relatively high Physical Activity Intensities compared with individuals of similar ages in high-income countries, regardless of their nutritional status.

Is the positive association between middle-income and rich household wealth and adult sub-Saharan African women's overweight status modified by the level of education attainment? A cross-sectional study of 22 countries

Background

Previous studies show a positive association between household wealth and overweight in sub-Saharan African (SSA) countries; however, the manner in which this relationship differs in the presence of educational attainment has not been well-established. This study examined the multiplicative effect modification of educational attainment on the association between middle-income and rich household wealth and overweight status among adult females in 22 SSA countries. We hypothesized that household wealth was associated with a greater likelihood of being overweight among middle income and rich women with lower levels of educational attainment compared to those with higher levels of educational attainment.

Methods

Demographic and Health Survey (DHS) data from 2006 to 2016 for women aged 18–49 years in SSA countries were used for the study. Overweight was defined as a body mass index (BMI) ≥ 25 kg/m². Household wealth index tertile was the exposure and educational attainment, the effect modifier. Potential confounders included age, ethnicity, place of residence, and parity. Descriptive analysis was conducted, and separate logistic regression models were fitted for each of the 22 SSA countries to compute measures of effect modification and 95% confidence intervals. Analysis of credibility (AnCred) methods were applied to assess the intrinsic credibility of the study findings and guide statistical inference.

Results

The prevalence of overweight ranged from 12.6% in Chad to 56.6% in Swaziland. Eighteen of the 22 SSA countries had measures of effect modification below one in at least one wealth tertile. This included eight of the 12 low-income countries and all 10 middle income countries. This implied that the odds of overweight were greater among middle-income and rich women with lower levels of educational attainment than those with higher educational attainment. On the basis of the AnCred analysis, it was found that the majority of the study findings across the region provided some support for the study hypothesis.

Conclusions

Women in higher wealth strata and with lower levels of educational attainment appear to be more vulnerable to overweight compared to those in the same wealth strata but with higher levels of educational attainment in most low- and middle- income SSA countries.

Rural South African Community Perceptions of Antibiotic Access and Use: Qualitative Evidence from a Health and Demographic Surveillance System Site

Knowledge and practices of rural South African populations with regard to antibiotic access and use (ABACUS) remain understudied. By using the case of four villages in the north east of the country, our aim was to investigate popular notions and social practices related to antibiotics to inform patient-level social interventions for appropriate antibiotic use. To achieve this, we investigated where community members (village residents) were accessing and sourcing medication, and what they understood antibiotics and antibiotic resistance (ABR) to be. Embedded within the multicountry ABACUS project, this qualitative study uses interviews and focus group discussions. A sample of 60 community members was recruited from the Agincourt Health and Demographic Surveillance System, situated in Mpumalanga Province, from April to August, 2017. We used the five abilities of seek, reach, pay, perceive, and engage in access to healthcare as proposed by Levesque’s “Access to Healthcare” framework. Respondents reported accessing antibiotics prescribed from legal sources: by nurses at the government primary healthcare clinics or by private doctors dispensed by private pharmacists. No account of the illegal purchasing of antibiotics was described. There was a mix of people who finished their prescription according to the instructions and those who did not. Some people kept antibiotics for future episodes of infection. The concept of “ABR” was understood by some community members when translated into related Xitsonga words because of knowledge tuberculosis and HIV/AIDS treatment regimens. Our findings indicate that regulation around the sale of antibiotics is enforced. Safer use of antibiotics and why resistance is necessary to understand need to be instilled. Therefore, context-specific educational campaigns, drawing on people’s understandings of antibiotics and informed by the experiences of other diseases, may be an important and deployable means of promoting the safe use of antibiotics.

A qualitative research synthesis of contextual factors contributing to female overweight and obesity over the life course in sub-Saharan Africa

Objective

Adult women are disproportionately affected by overweight and obesity in Sub-Saharan African (SSA) countries. Existing evidence on the sociocultural context remains unconsolidated. In this qualitative research synthesis, we aggregate research literature on contextual factors that potentially predispose adult women and adolescent girls to overweight and obesity to inform research, policies and programs over the life course.

Methods

PubMed, CINAHL, PsychInfo, ProQuest Central, EMBASE, and Web of Science were searched to locate qualitative research articles conducted in SSA countries beginning in the year 2000. After assessment for eligibility and critical appraisal, 17 studies were included in the synthesis. Textual data and quotes were synthesized using meta-aggregation methods proposed by the Joanna Briggs Institute.

Results

The synthesized studies were conducted in South Africa, Ghana, Kenya and Botswana. The three overarching themes across these studies were body size and shape ideals, barriers to healthy eating, and barriers to physical activity, with cultural and social factors as cross-cutting influences within the major themes. Culturally, the supposedly ideal African woman was expected to be overweight or obese, and voluptuous, and this was associated with their identity. Although being overweight or obese was not acceptable to adolescent girls, they desired to be voluptuous. Healthy food choices among women and adolescent girls were hampered by several factors including affordability of nutritious foods and peer victimization. Both adult women and adolescent girls experienced ageism as a barrier to physical activity.

Significance

This is the first qualitative research synthesis to amplify the voices of women and girls in SSA countries highlighting the challenges they face in maintaining a healthy body weight. Sociocultural, institutional and peer-related factors were powerful forces shaping body size preferences, food choices and participation in physical activity. Our study findings provide insights for the design of contextually appropriate obesity prevention interventions and lay the foundation for further research studies.

Benefits of Activity-Based Interventions Among Female Adolescents Who Are Overweight and Obese

PURPOSE

The purpose of this study was to compare the effects of 2 activity-based motor interventions among female adolescents who are overweight and obese.

METHODS

This study was conducted in a low-income community of Cape Town, South Africa. The study involved 52 participants classified as overweight and obese. Participants were randomly assigned to task-oriented functional training or Wii Fit intervention. Both interventions were 45 minutes of active training once a week for 14 weeks. Outcome measures included aerobic fitness, motor coordination, and self-efficacy. Data were collected before and after the interventions.

RESULTS

Participants in both groups demonstrated significant improvement in aerobic fitness and motor coordination but not self-efficacy. However, no between-group differences were observed on any of the outcomes.

CONCLUSIONS

Activity-based interventions may improve aerobic fitness and motor coordination in female adolescents who are overweight and obese and may also help prevent declines in physical fitness and coordination in this population.

Associations between physical inactivity, major depressive disorder, and alcohol use disorder in people living with HIV in a Ugandan fishing community

The aim of this cross-sectional study was to explore which variables were associated with physical inactivity in people living with HIV living in a fishing community in Uganda. Secondary aims were to explore the reasons for and barriers to physical activity (PA). Two hundred and fifty-six individuals living with HIV (77 men, 40.5 ± 10.3 years) completed the Physical Activity Vital Sign (PAVS), Patient Health Questionnaire-9 (PHQ-9), and the Alcohol Use Disorders Identification Test. Women had a 1.62 (95% CI = 1.01–2.57), those not having a job a 2.81 (95% CI = 2.00–3.94), and those with depression a 5.67 (95% CI = 2.27–14.17) higher odds for not being physically active for 150 min/week at moderate intensity. Employment and depression status were the only independent significant predictors explaining 27.2% of the PAVS variance. Becoming more healthy and energetic again and reducing stress were the most important PA motives, and musculoskeletal pain, body weakness, and lack of time were the most important PA barriers.

Perceived barriers and facilitators for healthy behaviours among parents of adolescents receiving mental health care in a public hospital in Cape Town, South Africa: A qualitative study

Objective: To explore the perceived barriers and facilitators for healthy behaviours among parents and caregivers of adolescents receiving mental health care in Cape Town, South Africa. Method: Thirty-five qualitative in-depth interviews were conducted with parents and caregivers of adolescents receiving mental health treatment by six facilitators matched for language. The data was analysed using thematic analysis. Results: The participants were predominantly female (n = 28, 80%) and parents (n = 29, 83%) of the adolescents. Personal barriers to good health included unhealthy eating, substance use and physical inactivity. Environmental barriers were inherited medical conditions, the easy availability of unhealthy foods and the absence of recreational facilities in communities. Perceived facilitators to good health were parental role modelling, planning and preparing healthy meals, exercise opportunities providing by walking long distances to work, and doing physically demanding jobs and household chores. Conclusion: Parents and caregivers are essential to adolescents' healthy development as they may influence adolescent health behaviours. It is likely that the promotion of positive health behaviours may be achieved though family-based interventions.

Childhood Obesity Prevention in Africa: A Systematic Review of Intervention Effectiveness and Implementation

Childhood obesity is of increasing concern in many parts of Africa. We conducted a systematic search and review of published literature on behavioural childhood obesity prevention interventions. A literature search identified peer-reviewed literature from seven databases, and unindexed African journals, including experimental studies targeting children age 2–18 years in African countries, published in any language since 1990. All experimental designs were eligible; outcomes of interest were both behavioural (physical activity, dietary behaviours) and anthropometric (weight, body mass index, body composition). We also searched for process evaluations or other implementation observations. Methodological quality was assessed; evidence was synthesised narratively as a meta-analysis was not possible. Seventeen articles describing 14 interventions in three countries (South Africa, Tunisia and Uganda) were included. Effect scores indicated no overall effect on dietary behaviours, with some beneficial effects on physical activity and anthropometric outcomes. The quality of evidence was predominantly weak. We identified barriers and facilitators to successful interventions, and these were largely resource-related. Our systematic review highlights research gaps in targeting alternative settings to schools, and younger age groups, and a need for more rigorous designs for evaluating effectiveness. We also recommend process evaluations being used more widely.

Mobile phone use among patients and health workers to enhance primary healthcare: A qualitative study in rural South Africa

Mobile phones have the potential to improve access to healthcare information and services in low-resourced settings. This study investigated the use of mobile phones among patients with chronic diseases, pregnant women, and health workers to enhance primary healthcare in rural South Africa. Qualitative research was undertaken in Mpumalanga in 2014. Semi structured in-depth interviews were conducted with 113 patients and 43 health workers from seven primary healthcare clinics and one district hospital. Data were thematically analysed. We found that some health workers and patients used their own mobile phones for healthcare, bearing the cost themselves. Patients used their mobile phones to remind themselves to take medication or attend their clinic visits, and they appreciated receiving voice call reminders. Some patients and health workers accessed websites and used social media to gather health information, but lacked web search strategies. The use of the websites and social media was intermittent due to lack of financial ability to afford airtime among these patients and health workers. Many did not know what to search for and where to search. Doctors have developed their own informal mobile health solutions in response to their work needs and lack of resources due to their rurality. Physical and social factors influence the usability of mobile phones for healthcare, and this can shape communication patterns such as poor eyesight. The bottom-up use of mobile phones has been evolving to fill the gaps to augment primary care services in South Africa; however, barriers to access remain, such as poor digital infrastructure and low digital literacy.

Cardiorespiratory fitness levels and associations with physical activity and body composition in young South African adults from Soweto

Background

This observational study aims to describe fitness, and objectively measured physical activity levels and patterns in 409 young black South African adults (aged 19–20 years) from Soweto, as well as to examine associations between physical activity, fitness and BMI.

Methods

A sub-maximal ramped step test was used to obtain an estimate of maximal oxygen uptake (VO_2max). Physical activity was measured using ActiGraph (GT1M) for 7 days in 256 participants. Time spent in sedentary (<100 counts per minute (cpm)), moderate (2020–5998 cpm) and vigorous (≥5999 cpm) intensity activity was calculated, and 90% of participants were considered active. Data are presented as mean(CI) or median(CI).

Results

Overweight and obesity was more prevalent in females than males (35% vs 8%, p < 0.001). Males had a higher VO_2max than females (41.9(41, 43) vs 32.6(32, 33)mlO₂/kg/min, p < 0.001); spent more time in moderate to vigorous intensity physical activity (MVPA) (83(80, 94) vs 43(38, 45)min/day, p < 0.001), and less time in sedentary behaviours (541(541, 567) vs 575(568, 597)min/day, p < 0.01). Sedentary time was not associated with VO_2max, however BMI was inversely associated, and MVPA was positively associated, with VO_2max (both p < 0.001).

Conclusions

The majority of young South African adults in this study were sufficiently active, and higher MVPA was associated with fitness. However, the high level of sedentary behaviour in this population is of concern and may be contributing to the increasing prevalence of overweight and obesity in this population. Young South African females are at greatest risk for decreased cardiovascular fitness and should be the focus for future interventions.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4212-0) contains supplementary material, which is available to authorized users.

Physical activity correlates in people living with HIV/AIDS: a systematic review of 45 studies

PURPOSE

Understanding barriers and facilitators of physical activity participation in persons living with HIV/AIDS is an essential first step in order to devise effective interventions. The present review provides a systematic quantitative review of the physical activity correlates in people with HIV/AIDS.

METHODS

Major electronic databases were searched till August 2016. Keywords included "physical activity" or "exercise" or "sports" and "AIDS" or "HIV".

RESULTS

Out of 55 correlates from 45 studies (N = 13,167; mean age range = 30.5-58.3 years; 63.2% male) five consistent (i.e., reported in four or more studies) correlates were identified. Lower levels of physical activity were consistently associated with older age (6/10 studies), a lower educational level (6/7), a lower number of CD4 cells/μl (7/11), exposure to antiviral therapy (4/6), and the presence of lipodystrophy (4/4). Other important barriers were the presence of bodily pain (2/2), depression (3/3), and opportunistic infections (3/4). Facilitators were a higher cardiorespiratory fitness level (3/3), a higher self-efficacy (2/2), more perceived benefits (2/2), and a better health motivation (3/3).

CONCLUSIONS

The current review has elucidated that participation in physical activity by people with HIV/AIDS is associated with a range of complex factors which should be considered in rehabilitation programs. Implications for Rehabilitation Health care professionals should consider HIV-related bodily pain and feelings of depression when assisting people living with HIV in inititiating and maintaining an active lifestyle. Interventions to improve self-efficacy and motivation, and to help people living with HIV in understanding the benefits of exercise, may encourage greater participation.

Interventions to prevent maternal obesity before conception, during pregnancy, and post partum

Prevention of obesity in women of reproductive age is widely recognised to be important both for their health and for that of their offspring. Weight-control interventions, including drug treatment, in pregnant women who are obese or overweight have not had sufficient impact on pregnancy and birth outcomes, which suggests that the focus for intervention should include preconception or post-partum periods. Further research is needed into the long-term effects of nutritional and lifestyle interventions before conception. To improve preconception health, an integrated approach, including pregnancy prevention, planning, and preparation is needed, involving more than the primary health-care sector and adopting an ecological approach to risk reduction that addresses personal, societal, and cultural influences. Raising awareness of the importance of good health in the period before pregnancy will require a new social movement: combining bottom-up mobilisation of individuals and communities with a top-down approach from policy initiatives. Interventions to reduce or prevent obesity before conception and during pregnancy could contribute substantially to achievement of the global Sustainable Development Goals, in terms of health, wellbeing, productivity, and equity in current and future generations.

Type 2 diabetes mellitus in African women

Compared to global estimates, Sub-Saharan Africa (SSA) has the highest projected rates of increase in type 2 diabetes (T2D) over the next 25years. This is attributed to the ageing population, increasing urbanisation and the associated lifestyle changes. Although the prevalence does not differ by gender, deaths attributable to T2D in SSA are greater in women, likely due to differences in beliefs and access to care. Women in SSA also have greater risk factor burden for T2D than men, in particular obesity, which is explained in part by sociocultural factors. The pathogenesis of diabetes differs between African and Caucasian women, with implications for risk assessment. African women are more insulin resistant than their Caucasian counterparts, despite a more 'favourable' body fat distribution. Notably, women in SSA face the dual burden of T2D and HIV/AIDS. HIV positive women in SSA are typically young and obese, with the latter being exacerbated by anti-retroviral therapy (ART). Cultural perceptions regarding weight loss and limited financial resources are the major limitations to the management of T2D. Hence prevention is vital. However, there is a paucity of studies examining the effectiveness and sustainability of interventions to reduce T2D in SSA.

The effect of exergames on functional strength, anaerobic fitness, balance and agility in children with and without motor coordination difficulties living in low-income communities

Children with Developmental Coordination Disorder (DCD) are physically less active, preferring more sedentary behavior and are at risk of developing health problems or becoming overweight. 18 children (age 6-10years) with lower levels of motor coordination attending a primary school in a low-income community in South Africa (score on Movement Assessment Battery for Children Second edition equal to or below the 5th percentile) were selected to participate in the study and were age-matched with typically developing peers (TD). Both groups of children engaged in 20min of active Nintendo Wii Fit gaming on the balance board, twice a week for a period of five weeks. All children were tested before and after the intervention using the lower limb items of the Functional Strength Measurement, the 5×10 meter sprint test, the 5×10 meter slalom sprint test, and the Balance, Running speed and Agility subtest of the Bruininks Oseretsky Test of Motor Proficiency 2nd edition (BOT-2). After intervention, both groups of children improved in functional strength and anaerobic fitness. The magnitude of these changes was not related to participant's motor coordination level. However, differences in change between the TD and DCD group were apparent on the motor performance tests; children with DCD seemed to benefit more in balance skills of the BOT-2, while the TD children improved more in the Running speed and Agility component of the BOT-2. Compliance to the study protocol over 5weeks was high and the effect on physical functioning was shown on standardized measures of physical performance validated for children with and without DCD.

Bisphenol A Promotes Adiposity and Inflammation in a Nonmonotonic Dose-response Way in 5-week-old Male and Female C57BL/6J Mice Fed a Low-calorie Diet

A growing body of epidemiological research show that Bisphenol A (BPA) is positively correlated with obesity and metabolic disorders. However, the mechanisms of BPA on adiposity remain largely unknown. In this study, we found that 5-week-old male and female C57BL/6J mice exposed to four dosages of BPA (5, 50, 500, and 5000 μg/kg/d) by oral intake for 30 days showed significantly increased body weight and fat mass in a nonmonotonic dose-dependent manner when fed a chow diet. The effect occurred even at the lowest concentration (5μg/kg/d), lower than the tolerable daily intake of 50 μg/kg/day for BPA. However, no significant difference in body weight and fat mass was observed in either male or female mice fed a high-fat diet, suggesting that BPA may interact with diet in promoting obesity risk. In vitro study showed that BPA treatment drives the differentiation of white adipocyte progenitors from the stromal vascular fraction, partially through glucocorticoid receptor. BPA exposure increased circulating inflammatory factors and the local inflammation in white adipose tissues in both genders fed a chow diet, but not under high-fat diet. We further found that BPA concentration was associated with increased circulating inflammatory factors, including leptin and TNFα, in lean female subjects (body mass index < 23.0 kg/m(2)) but not in lean male subjects or in both sexes of overweight/obese subjects (body mass index > 25.0 kg/m(2)). In conclusion, we demonstrated the nonmonotonic dose effects of BPA on adiposity and chronic inflammation in 5-week-old mice, which is related to caloric uptake.

Application of Intervention Mapping to develop a community-based health promotion pre-pregnancy intervention for adolescent girls in rural South Africa: Project Ntshembo (Hope)

BACKGROUND

South Africa (SA) is undergoing multiple transitions with an increasing burden of non-communicable diseases and high levels of overweight and obesity in adolescent girls and women. Adolescence is key to addressing trans-generational risk and a window of opportunity to intervene and positively impact on individuals' health trajectories into adulthood. Using Intervention Mapping (IM), this paper describes the development of the Ntshembo intervention, which is intended to improve the health and well-being of adolescent girls in order to limit the inter-generational transfer of risk of metabolic disease, in particular diabetes risk.

METHODS

This paper describes the application of the first four steps of IM. Evidence is provided to support the selection of four key behavioural objectives: viz. to eat a healthy, balanced diet, increase physical activity, reduce sedentary behaviour, and promote reproductive health. Appropriate behaviour change techniques are suggested and a theoretical framework outlining components of relevant behaviour change theories is presented. It is proposed that the Ntshembo intervention will be community-based, including specialist adolescent community health workers who will deliver a complex intervention comprising of individual, peer, family and community mobilisation components.

CONCLUSIONS

The Ntshembo intervention is novel, both in SA and globally, as it is: (1) based on strong evidence, extensive formative work and best practice from evaluated interventions; (2) combines theory with evidence to inform intervention components; (3) includes multiple domains of influence (community through to the individual); (4) focuses on an at-risk target group; and (5) embeds within existing and planned health service priorities in SA.