Original ResearchAssociations of intention to undertake physical activity among community dwelling British South Asian adults aged 60 years and over: a cross-sectional study
Introduction
Increasing physical activity (PA) levels across the life span is a major public health challenge. About 60% of the world's population does not achieve the recommended minimum of 150 min of moderate-intensity PA over the week.1 In England, only 19% of people aged 65–74 years and 6% of people aged 75+ years meet the recommended PA targets.2 PA levels are lower amongst black and minority ethnic (BME) groups, particularly South Asian (SA) older adults (those originating from the countries of Bangladesh, India and Pakistan). Compared with European whites, British SA adults are 60% less likely to meet the recommended PA targets3 with only 11% of SA men and 8% of SA women aged 55+ years undertaking recommended levels of PA4 but are at increased risk of stroke and type-2 diabetes.5
Increasing PA among SA older adults can be difficult as a number of generic and sociocultural barriers exist. For example, many SA men and women report generic barriers such as cost, personal safety, lack of time outside of long working hours and career commitments as negatively influencing PA uptake and maintenance.6, 7 Complex cultural beliefs about family roles/expectations, religious requirement for modesty, cultural rejection of a ‘sporting’ identity or dress, language barriers and health knowledge can make becoming more physically active challenging.6, 8
PA is also influenced by social cognitive determinants. Unwillingness to participate in PA is related to beliefs about and attitudes to PA and to perceived behavioural control (PBC). PBC refers to a person's confidence in their ability to carry out the intended action and may be influenced by perceived barriers to that action. To understand and explain PA intention and behaviour, the Theory of Planned Behaviour (TPB) is frequently used, and its predictive value is well-established.9 The TPB explains the process through which people change their behaviour, providing a useful starting point to identify possible behaviour change mechanisms, and how these can be addressed, when developing interventions.10 The TPB highlights the importance of beliefs in forming intention to change health-related behaviour and states that PA among adults is predicted by their intention to undertake PA. Behavioural intention can be explained by three social-cognitive determinants—attitude, subjective norm, and PBC.10 Attitude towards behaviour is determined by beliefs about the consequences of adopting that behaviour and is determined by behavioural beliefs, i.e. perceptions regarding the advantages/disadvantages of the behaviour. Subjective norm refers to the perceived social approval for the behaviour, determined by expectations regarding whether important reference individuals or groups will approve the behaviour.
SA subgroups vary in terms of religion, culture and language and demonstrate a mixed profile of health behaviours, including PA.3 Research relating to ethnicity and health needs to examine diversity within BME groups to avoid homogenisation.11 Although studies have investigated the determinants of PA behaviour among SA older adults,6 none have explored subgroup variations using the TPB. To enable the development of effective PA interventions, tailored to the needs of Indian, Pakistani and Bangladeshi older adults, it is important to understand what determines PA intention in each subgroup. Therefore, this study aimed to determine the sociocognitive associations of intention to undertake PA among separate groups of Indian, Pakistani and Bangladeshi older adults aged ≥60 years using the TPB.
Section snippets
Methods
Participants were recruited from 10 general practices in the North West of England, UK. Given that minority groups are less likely to respond to surveys,12 we purposively sampled practices with a greater number of people from SA ethnic groups than in the general population. Patients who were terminally ill, had severe mental illness, had moderate-to-severe dementia, had moved away or were recently deceased were excluded.
The questionnaire was developed from previous qualitative work exploring SA
Results
The survey was sent out to 972 SA people aged ≥60 years. Screening excluded patients who were terminally ill, had severe mental illness, moderate-to-severe dementia, had moved away or were recently deceased, but eight questionnaire packs were returned undelivered. From the resulting adjusted sample of 964 people, 138 people returned the questionnaire (14.3% of the adjusted total), with 134 (13.9% of the adjusted total) returning it fully completed. A summary of the demographics is shown in
Discussion
This study investigated the ethnicity differences among SA older adults intention to undertake PA and self-reported PA using the TPB. However, this study found that intention did not correlate with the amount of PA undertaken and finds support in the literature, which highlights the poor translation of behavioural intentions into behaviour.17 The use of implementation intentions, or 'If-Then' plans, have been found to improve rates of intention-behaviour translation18 and offer a potentially
Ethical approval
The study was approved by the North West Research Ethics Committee (12/NW/0586).
Funding
The research project was funded by the NIHR Greater Manchester Collaboration for Leadership in Applied Health Research and Care (CLAHRC), RCF_R9_MH. The funding body had no input to the design of the study and collection, analysis, and interpretation of data or in writing the manuscript.
Competing interests
None declared.
References (36)
- et al.
Levels of physical activity and relationship with markers of diabetes and cardiovascular disease risk in 5474 white European and South Asian adults screened for type 2 diabetes
Prev Med
(2010) - et al.
What are the barriers and facilitators to exercise and physical activity uptake and adherence among South Asian older adults: a systematic review of qualitative studies
Prev Med
(2012) The theory of planned behaviour
Organ Behav Hum Decis Process
(1991)- et al.
Intervention-related cognitive versus social mediators of exercise adherence in the elderly
Am J Prev Med
(2002) - et al.
The influence of primary health care professionals in encouraging exercise and physical activity uptake among White and South Asian older adults: experiences of ‘young’ older adults
Patient Educ Couns
(2010) Global recommendations on physical activity for health
(2010)Health survey for England adult trend tables 2007
(2008)- et al.
Subgroup differences in psychosocial factors relating to coronary heart disease in the UK South Asian population
J Psychosom Res
(2010) - et al.
Perspectives on enhancing physical activity and diet for health promotion among at-risk urban UK South Asian communities: a qualitative study
BMJ Open
(2015)