Participation in a community-level health intervention

Gayton, Sarah Pearl (2019) Participation in a community-level health intervention. Masters (Research) thesis, James Cook University.

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Abstract

Physical inactivity is becoming more widespread, and with it, increases in obesity and other co-morbid conditions. Community-level health interventions have been introduced globally to encourage physical activity participation and other positive health choices. It is important to consider what attracts and retains participants, and to examine if the programs positively impact upon their health behaviours. Understanding these factors could assist in greater engagement, sustainability and create long-term behaviour change.

The Australian Government introduced Healthy Community Initiatives in 82 local government areas between 2011-2014 to reduce the risk of chronic disease associated with physical inactivity. The Tablelands Regional Council, in the highlands west of Cairns, Queensland, was one of the councils to implement the initiative. Named 'Wellbeing Tablelands', two of the programs offered under the initiative were light water aerobics sessions and Beat It. The water aerobics program targeted older adults and focused on gentle movement and stretching. The program had one session per week for ten weeks and catered to individuals with limited mobility due to their age. The other program, Beat It, offered two sessions per week over twelve weeks, and catered to those with average as well as impaired mobility. It was more demanding and targeted those at risk of or coping with diabetes.

Participants of these two programs were invited to partake in the current study. The study uses a convergent mixed methods approach to answer the research question 'What are the physiological and psychological factors and the personal experiences associated with participation in the Wellbeing Tablelands HCI programs?'. Qualitative interviews were used to understand the personal experiences of participation in the community-level health interventions, as well as the facilitators perspectives on what they believe the experience of the participant is. Psychometric measures were used for the participants' self-efficacy, self-determination and stage of change. Physiological changes measured included BMI, waist circumference, blood pressure, resting heart rate, flexibility and strength.

Thirty-three participants took part in the program (23 female, 10 male), aged between 47 to 79 years. Four participants took part in the light water aerobics, and the remaining 29 participants took part in the Beat It program. Twenty-five participants were interviewed about their personal experiences of participation in the programs. Four facilitators from the programs and the local council also took part in qualitative interviews to explore their perspectives on program participation. Braun and Clarke's Thematic Analysis was used to guide the qualitative data analysis.

Body mass index, waist circumference, resting heart rate and resting blood pressure were also measured for 29 participants, as well as sit-to-stand, sit-and-reach, leg balance, seated medicine ball throw and six-minute walk. Psychological measures included self-efficacy, self-determination and stage of change. Wilcoxon Signed Ranks Tests were used to assess if there were differences from assessment 1 to 2 for the quantitative data.

There were significant improvements for waist circumference for both genders, as well as the male participants' BMI. There were significant improvements for the female participants' sit-and-reach and sit-to-stand, and the men's seated medicine ball throw. For the psychometric measures, the only score to significantly improve was the autonomous subscale of the treatment self-determination scale, indicating that autonomous motivation to attend the program increased over the duration of the program.

The thematic analysis of the participants' interviews resulted in five themes for the personal experience of participation. These themes were 'Exercise to me', 'Physical benefits of exercise', 'Psychological benefits of exercise', 'Health behaviour barriers' and 'Health behaviour enablers'. The themes of the facilitators interviews were 'Understanding of barriers', 'Program elements as enablers', 'Health advocate enablers', 'Social enablers' and 'Overall impressions'.

The objective of the Healthy Communities Initiative was to reduce the risk of chronic disease associated with physical inactivity however, the results demonstrate that the participants were not necessarily attending for that reason. The theme common to all participants was appreciation of the opportunity to socialise, and some were also encouraged by changes they noticed in their physiological characteristics. Several participants also had the goal to maintain their current level of physical ability.

Qualitative results also demonstrate that the participants felt more confident with their physical abilities after participating in the program, and they planned on continuing to do physical activity after the program ended. This was despite there not being a significant increase in the psychometric measure for self-efficacy.

There was a discrepancy between the quantitative psychometric measures and qualitative results. While there were no significant improvements for self-efficacy, the participants qualitative data indicated that they felt more confident with their ability, and they desired to continue exercising following the program. Facilitators identified the barriers that participants said were their main barriers to engaging in physical activity, including cost, transport and time; however, it appeared that the facilitators underestimated the health knowledge of participants. The study provides an account of participation in a community-level health intervention, and may contribute to improved program design that is more appealing and relevant to prospective participants.

Item ID: 63716
Item Type: Thesis (Masters (Research))
Keywords: health, community health, fitness, health psychology, behaviour, physical inactivity, Wellbeing Tablelands
Copyright Information: Copyright © 2019 Sarah Pearl Gayton.
Date Deposited: 06 Jul 2020 22:28
FoR Codes: 17 PSYCHOLOGY AND COGNITIVE SCIENCES > 1701 Psychology > 170106 Health, Clinical and Counselling Psychology @ 100%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920401 Behaviour and Health @ 100%
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