Barriers to physical activity among the adolescents (Age 13-18 Years) in rural and urban areas of Deptford
Abstract
Objectives: Physical activity among the adolescents is associated with psychological, social and physical benefits. Moreover, research indicates that physical activeness observed in adulthood originates from childhood. Physical inactivity is associated with obesity and diabetes type 2 (Craggs et al., 2011). This study is developed to explore physical activity barriers in a representative sample of adolescent in Deptford, London Borough of Lewisham.
Design: The study is conducted in rural and urban areas of Deptford in London Borough of Lewisham. The study design is mixed research design. The quantitative part will consist of 159 randomly selected adolescents, whereas the qualitative part will consist of semi-structured interviews with the participants and focus group discussions.
Outcomes: The study findings will identify the physical activity barriers among the adolescents, and the strategies to overcome them.
Conclusion: Increase of public knowledge on importance of physical activity is crucial as it helps the society to understand the health benefits of adopting active lifestyles. The study findings help in understanding physical activity determinants among the adolescents (13-18 years).
Title: Barriers to physical activity among the adolescents (Age 13-18 Years) in rural and urban areas of Deptford
Background
Physical activity is associated with psychosocial and physical benefits for everyone including children and young adults. Physical inactivity correlates with increase of lifestyle diseases such as diabetes type 1 and obesity among the adolescents. The current levels of physical activity in the UK are low (Rothon et al., 2010). For instance, in England, only 66% of males and 56% of females meet the recommended physical activeness. In Scots, only 62% of the population is physically active. These findings may not be realistic as most of the studies conducted are self-reporting, which indicates that the reporting could be a little bit biased but it portrays the exact picture on levels of physical activeness among the UK (Department of Health, 2011).
Research indicates that physically active lifestyle originates from childhood. Therefore, childhood health promotion is an effective strategy in obesity prevention (Craggs et al., 2011). In the UK, several community based programs and school based programs have been developed to increase physical activeness knowledge and health benefits in the population. However, increasing health activity information in the community does not automatically translate to increase in physical activeness among the adolescents. Therefore, this paper explores the determinants of exercise among the adolescent. The findings gathered will help to design effective interventions that will increase adolescent’s physical activeness across the ethnic groups (Rothon et al. 2010).
Study Problem / Purpose
High levels of physical activeness in young lives are associated with normal skeletal development, increased wellbeing, good-metabolic, and cardiovascular system. However, physical activeness in the UK is a huge public health concern, and is shown to decline in adolescence (Craggs et al., 2011). There are a number of factors that influence physical activity including biological, environmental, psychological and social factors. In depth interviews on physical activity among the youth have also been explored, where socioeconomic status, gender and societal (peer and parents) have been correlated with physical activity or inactiveness among the adolescents (Craggs et al., 2011).
However, these study findings correlates mainly to cross-sectional differences and therefore are limited to formulation of hypothesis concerning the potential mediators and factors. Therefore, this study explores factors that hinder physical activity by examining the potential barriers of physical activity among the youth. The purpose of this paper is to strengthen the evidence base in order to inform the process of designing effective interventions (Oliveira, 2013).
Relevance / Study Rationale
Physical inactiveness is associated with wide range of health complications such as cardiovascular disease, type-2 diabetes, obesity and psychosocial disorders such as low self esteem, depression, and eating disorders. Childhood obesity is a growing threat to the UK’s public health (Oliveira, 2013). In UK, 3 out of every 10 children between age 2 and 15 are obese or overweight, and 1 in six children in the same group is obese.
Research estimates that these lifestyle diseases reduce life expectancy of the adolescents, and account for 1-3% total health expenditures. Psychiatric morbidity in adolescents is a major issue in the USA. The median prevalence of mental health in adolescents in UK is 10%. Most population based cohort investigations as randomized controlled trials associated with depressive symptoms in adolescents (Craggs et al., 2011).
Physical inactivity is the leading cause of mortality in developed countries, and it accounts for 22-23% of cardiovascular diseases, 17% colon cancer, 13% strokes, 15% diabetes and 11% breast cancer incidences. In Scotland, physical inactivity contributes to 2,500 deaths per year and consumes approximately £94 million of NHS health budget. Other non-aggregating non-healthcare costs such as low productivity leads to additional costs of £8.2 billion per annum, with additional £2.5 billion for addressing obesity and its related complication (Department of Health, 2011).
Lewisham borough of London is has the highest rate of childhood obesity. Statistics indicates that about 25% of Lewisham are below 20 years. The population is diverse, with 69% of school children are from minority ethnic background, with 37% of them living in poverty. The National Child Measurement Program (NCMP) reveals that prevalence of childhood obesity in this borough is higher than England average.
This is an indicator that adolescents residing in this borough are not physically active. Therefore, understanding barriers to physical activity in adolescents (representative sample) will help address the challenges, and in designing of effective strategies that promote physical activity among the vulnerable population group (Department of Health, 2011).
Brief Literature Review
Physical activeness among children and adolescents plays an important role. In current society, technology such as computers and social media has reduced the desire for young adults to play or be involved with any physical activity. Adolescent and children physical activeness decrease with age, with the decline is lower in boys and girls. The barriers associated with physical activities should be addressed with enthusiastic support and enthusiastic (Oliveira, 2013).
Sedentary lifestyle is identified as a high risk factor for cardiovascular and obesity. The prevalence rate of obesity and overweight in adolescents is a major public health concern. Physical activity is a habit acquired through influence friends, family, coaches, teachers and environment. Young people who are not exposed in environments that build their confidence in their physical abilities tend to adopt sedentary life. Research indicates that movement activities such as jumping, running, throwing serve as great building blocks for children physical activity. Therefore, children who lack avenues to develop these skills at young age are not likely to become physically activity in the future (Kelishadi et al. 2010).
Physical activity is essential for children healthy development. Research indicates that physical activities have beneficial effects on children body composition, blood sugar, cholesterol, and muscular strength. Physical activity is also associated with better academic performance and general well being. Instilling positive behaviors in children and adolescents makes them to carry over these behaviors into adulthood. Age and sex are the most demographic factors associated with physical activity in adolescence. Boys tend to be more active as compared to girls. Research indicates an inverse association between age and physical activity. Patient level of education and socioeconomic factors also determines the adolescent’s level of participation in physical activity. Age is inversely associated with physical activeness in adolescents. This indicates that as adolescents get older, their level of physical activity declines (Heitzler, 2010).
Psychiatric morbidity in adolescents is a major issue to public health. In a study that reviewed psychiatric disorders in children and adolescents indicated that the median prevalence to mental health condition is about 12%. In UK, a comprehensive study of mental disorders among children and adolescents was reported at 10% and 4% emotional disorders such as depression and anxiety. The emotional disorders were observed in adolescents than in children. If no effective treatment is put in place, the children and adolescents are at risk of having poor academic results, isolation, substance abuse and suicidal thoughts.
There is increase in literature that associates physical activity with reduction in emotional disorders on adults, but there is limited research on its effectiveness in adolescents (Rothon et al. 2010). The increased frequency of mental illness in adolescents and its associated long-term complications makes it important area to research on, particularly on protective factors. More research is required in order to explore further on the relationship between physical activity and reduction of mental disorders among children and adolescents because there is limited evidence of this issue from longitudinal studies (Rothon et al., 2010).
There are four key hypotheses of psychosocial explanations that explain the association of physical activity with reduction of emotional disorders. The first hypothesis posits that the ‘time-out’ provided by physical activity enhances mood. This theory has been supported by experiments that indicated that physical activity was more efficient in improving people’s mood during the relaxation period. The second explanation indicated that ‘mastery’ of the physical activity task such as learning of new tasks gives a person a sense of pride for a new achievement, which leads to improved mood(Gomes et al., 2016).
The third explanation suggests that the indirect effect of physical activity is that it provides opportunities for social interaction which also improves mood. The interaction during the exercise classes, team sports as well as social support that comes with it improves mental health. Lastly, physical activity relates with improved self efficacy and self esteem. People who engage in physical activity programs have the potential to modify their body shape and improve their self image which improves mental well being (Rothon et al. 2010).
Maternal education is inversely correlated with high trend of physical inactiveness. Research indicates that family house hold income is associated with vigorous and moderate physical activity. There is some positive association between presence of recreational facilities in the neighborhood and extent of children physical activity. The proximity of playgrounds and parks was positively associated with physical activity. There is positive association between safety of neighborhoods and physical activity among the adolescents. Other determinants include weather and presence of sidewalks as well as bike lanes (Oliveira, 2013).
Understanding physical activity barriers in developed countries is important when developing of effective strategy. In most literature, lack of moral support from families and peers and lack of psychological support is one of the main barriers to physical activeness among the adolescents. Most parents believes in children’s education achievement which makes them place it as a priority and limits the availability of safe and easy access for the adolescents, inhibiting them an active health lifestyles. Children from families with high socioeconomic status have low level of physical activity.
This is an indicator that the successful parents put priority to studying and achieving of good grades. This is attributable to insufficient knowledge on importance of integrating physical activity in their routine lives. Therefore, increasing community knowledge on importance of physical activity, and ways it boosts children learning activity and school performance will make them adopt physical activeness as their lifestyle (Dunton et al., 2009; Gomes et al., 2016).
With increase in technical advancement, it has made peoples life to be easy and convenience and increasingly less active. However, individual person may have their own reason for living a sedentary life. The most common reasons for not exercising is lack of time to exercise, low self motivation, lack of interest and enjoyment of exercise, boredom, low confidence and ability to become physically active, fear of having injuries, low self efficacy, inability to set personal goals, poor self management skills, low support and encouragement. However, the major personal barrier to engaging in physical activity includes energy, time and motivation issues (Gomes et al., 2016).
A study conducted in 2013 aimed at identifying the external and internal barrier to physical activity as well as exercise among middle aged women and geriatric population indicated that their major challenge is lack of time and inadequate physical facilities. Other issues identified were cost, transportation and safety issues. The environment and its neighborhood influence children level of physical activity.
There are many factors that affect people in the society including availability of cycling trails, walking paths as well as recreational facilities. Factors such as transport availability, crime and pollution will discourage people from becoming physically active. The social environment also plays an integral role in influencing physical activeness among the adolescents (Ding et al., 2011).
Research Objectives / Research Question / Hypotheses
There is growing body of research focusing on association between physical activity and psychological as well as physical performance among the adolescents. To better understand these correlations, this study will examine the barriers to physical activity among this age group in order to develop scientific literature that can be used by the healthcare providers to design targeted interventions (Craggs et al., 2011).
The study theorizes that socioeconomic and social cognitive factors are the key determinants of physical activity among adolescents in rural and urban areas of Deptford, Lewisham borough of London. Therefore, the study’s hypothesis statement is as follows; In adolescents, socioeconomic and social cognitive factors, as compared demographics factors determine the level of physical activeness among the adolescents. The research question is – What are the barriers of physical activity among adolescents (13-18 years) residing in rural and urban areas of Deptford, Lewisham borough of London.
Study Methods
Study Design: The study designed used in this study is mixed research method. The research design is chosen so as to explore a phenomenon, describe it and report the findings. In this type of research design, combination of qualitative and quantitative research methods will be used to give a reasonable basis for developing evidence based strategy (Abbott and McKinney, 2013).
The study data will be collected from epidemiological study of adolescents from three schools in Deptford. The study participants will be recruited from three Local Education Authority (LEA) boroughs in Lewisham. Further funding will be obtained from the relevant authority to facilitate study follow up.
Subjects / Participants: There will be 159 participants aged (13-18 years) from comprehensive education facilities in Lewisham borough or London. The sample size is determined by size calculation sample.
Inclusion / exclusion criteria: The study participants must be 13-18 years of age. The participant should be from any ethnic group and socioeconomic status. The study will exclude participants with history of any disease, cannot communicate in English and are above 18 years of age.
Sampling: The study sample will be selected as guided by simple random sampling. This sampling method will help ensure that there is equal probability to select adolescents (age 13-18 years) when creating the study sample size. This sampling method is chosen because it will help reduce potential human errors when creating study sample.
This implies that the sample size used will be a highly representative of population being studied. This in turn will help the students make statistical inferences from the findings of the sample to the entire population.
Recruitment: Information about the study will be given to school representatives a week before school visit. The information will also be emailed to adolescent’s parents. Parents are allowed to opt out their child. The adolescents who will not be opted out will be randomly selected according to the study inclusion and exclusion criteria. The recruited participants will be invited in study rooms of respective schools, where they will be briefed about the study.
They will be issued with a written consent that must be signed by the student and their parents. Students were informed that they could withdraw from the study at their wish, and they could decline to answer questions that they did not like or were uncomfortable answering them.
Intervention details: The research team will administer the classrooms questionnaire that will be answered in 40-50 minutes. Three types of questionnaires will be used in this study. The first questionnaire is one that evaluates on students social cognitive factors, one that evaluate socio-demographic variables such as gender, age, family income and education and one that examines the level of physical activeness and environmental factors. To analyze the participant’s experiences and perceptions, grounded theory approach will be utilized.
This will consist of a total of 7 focus group discussions and 5 in-depth interviews to explore the students’ perception on physical activity and barrier to adopting physical active lifestyles. The focus group discussions and interviews will be done using semi-structured open-ended questions which will provide an opportunity for the respondents to explain in detail their perceptions and opinions about barriers to physical activity. The discussions will be audio taped and supplemented with short hand notes. The data collected from audiotapes will be transcribed and analyzed accordingly.
Variables / Data Collection: The questionnaires are designed to collect data variables such as subjective norms, attitudes, self efficacy, and behavioral control regarding physical attitudes. The information gathered will help the researcher formulate adolescents’ perception of physical activity and associated barriers. The questionnaire will be evaluated with 5- point Likert-type scale where 1 indicates Highly Disagree and 5 highly agree. For the qualitative study, the variables that will be collected by the focus group discussion include perceived barriers to physical activity (Abbott and McKinney, 2013).
Data analysis: For qualitative part of the study, the data collection will be done simultaneously with data analysis as guided by grounded theory approach. Therefore, data obtained from focus group talks and interviews will be analyzed manually and guided by constant comparative analysis. Analytical tools will be used to ask questions and for comparative analysis so as to identify emerging themes and concepts.
For quantitative study, the dependent variables include the level of physical activity (Vigorous, Moderate, and Low). The independent variables are socio-demographic factors such as ethnic background, age, gender, social cognitive factors, parent’s level of education, and socioeconomic variables. For these data, statistical analysis will be done using SPSS windows software (SPSS Inc., Chicago, IL, USA; Version 15.0). The statistical tests that will be conducted include Chi-square, analysis of variance (ANOVA), Spearman correlation, and logistic regression analysis. The significance level is set at p<0.05.
Ethical Considerations
The initiative aims at identifying barriers of physical activeness among adolescents residing in urban and rural areas of Deptford. This implies that before implementing the project, the researcher is expected to obtain approval and support from Institution review boards. In this case, the board committee will be briefed about the proposed project and its implication to public health.
This effective communication will help clear doubts held by the members. The informed consent will be used in order to ensure that the participants are well briefed about the study findings, and to ensure that they are not coerced or forced to participate in the proposed study (Bowling, 2014).
The participants used in this study are below 18 years, under the governing law, these people are still under their parents care. Therefore, written informed consent will be obtained from parents of each participants and oral assent will be required from each of the participants. Confidentiality is a major issue when dealing with the adolescents. Most of them will not open up unless you ensure them that their opinions will be protected.
To maintain confidentiality, the institutions names and names of the participants will be not mentioned, instead, each of the institution will be given a code, and the participants will be issued with numbers anonymously (Abbott and McKinney, 2013).
Other considerations
Limitations
The most common potential barriers in community based projects is inadequate knowledge, skills, poor attitudes towards evidence based projects, economic restrictions as well as so organizational influences (Dunton et al., 2009; Gomes et al., 2016). Lack of knowledge is a potential limitation as it results to inadequate understanding on how the evidence gathered promotes community’s well being.
This might make adolescents parents refuse to give consents. This is correlated to attitudinal barriers and weak beliefs, which are very difficult to control than knowledge barrier. The socio-organizational limitation includes little or no support from the managements and disagreements as well as conflicts among the involved stakeholders (Offredy and Vickers, 2013).
To overcome these barriers, effective strategies will be applied. This includes parent education about physical activity and its impacts on adolescent’s psychological and physical wellbeing. Parent education will be reinforced using pamphlets. In regards to economic crisis, the researcher will explore sources of funds through various agencies and charity acts. To remove attitudinal barriers and weak beliefs will be done through regular meeting to discuss the pros and cons of proposed interventions.
Effective communication is the key solutions to all research limitations. The weekly meeting and focus group discussion with the relevant stakeholders will enhance collaborative and supportive relationship. Research findings show that team oriented approaches enhances strong communication and promotes strong interaction between involved stakeholders (Bowling, 2014).
Budget
The project implementation will take approximately eight months. Effective implementation of the exercise will require planning. Part of the planning includes establishing preliminary budget which recognize the following areas (See Appendix 2). The annual cost for principle investigator is about £16000 for the eight months. The principle investigator assistant responsibilities will be to train the stakeholders about the project and assisting in data collection activities. The training cost of the participants and their parents will cost about £3000. The printing cost is estimated to be about £4000. Therefore, the total implementation cost is expected to be £28000.
Plans for Dissemination
The project will be implemented in six phases. The first phase is that of seeking approval from the Institutional Review Board (IRB) and head of department. IRB will review the safety and feasibility of the study in promoting public’s health. After approval, the second phase will involve planning and designing of the project. This involves strategies that outline project implementation process, funding and sourcing for resources (Tracy, 2012). The third and the fourth phase will involve carrying out of the proposed project.
This include recruitment process, screening the participants using the inclusion and exclusion criteria, signing of informed consent, carrying out individual interviews and focus group discussions and assessing participants cognitive, socio-demographic and socioeconomic factors. The five phases is the data collection and data analysis phase. The sixth phase will involve compiling the study findings, and making a comparative analysis with the existing literature so as to establish the evidence base (Abbott and McKinney, 2013).
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