It is important to understand barriers to Physical Activity (PA), particularly for under researched populations. While a lack of PA has been acknowledged as an important issue for those living in Afghanistan, there have been no published studies exploring barriers to PA within this population. Therefore, the purpose of this study was to explore barriers to PA for Afghans and how these differ depending on where they reside: UK or Afghanistan. 930 participants, 578 (291 males; 287 females) were recruited from Afghanistan and 352 (267 males; 85 females) from the UK. A culturally nuanced questionnaire exploring barriers to PA was developed and used to collect data via an online survey software programme. Bayesian ordinal models explored differences between population groups, with results suggesting some barriers are shared across populations but others more pertinent for a particular group. Lack of time and being too tired were barriers for both populations, but were rated higher by those living in Afghanistan; as was a lack of confidence and being uncomfortable with exercise clothing. Afghan females perceived a lack of single-sex facilities, not being able to participate in PA with males, and having to be fully covered outside of the home as important barriers to their PA, but these were more of a barrier for those residing in the UK. The findings highlight important considerations for trying to engage these populations in PA.
References
[1]
Al-Nakeeb, Y., Lyons, M., Collins, P., Al-Nuaim, A., Al-Hazzaa, H., Duncan, M. J., & Nevill, A. (2012). Obesity, Physical Activity and Sedentary Behavior amongst British and Saudi Youth: A Cross-Cultural Study. International Journal of Environmental Research and Public Health, 9, 1490-1506. https://doi.org/10.3390/ijerph9041490
[2]
Azimi, M. D., Najafizada, S. A. M., Khaing, I. K., & Hamajima, N. (2015). Factors Influencing Non-Institutional Deliveries in Afghanistan: Secondary Analysis of the Afghanistan Mortality Survey 2010. Nagoya Journal of Medical Science, 77, 133-143.
[3]
Babakus, W. S., & Thompson, J. L. (2012). Physical Activity among South Asian Women: A Systematic, Mixed-Methods Review. International Journal of Behavioral Nutrition and Physical Activity, 9, Article No. 150. https://doi.org/10.1186/1479-5868-9-150
[4]
Bauman, A., Ma, G., Cuevas, F., Omar, Z., Waqanivalu, T., Phongsavan, P., Keke, K., Bhushan, A., & Equity and Non-Communicable Disease Risk Factors Project Collaborative Group (2011). Cross-National Comparisons of Socioeconomic Differences in the Prevalence of Leisure-Time and Occupational Physical Activity, and Active Commuting in Six Asia-Pacific Countries. Journal of Epidemiology & Community Health, 65, 35-43.
[5]
Blake, H., Stanulewicz, N., & Mcgill, F. (2017). Predictors of Physical Activity and Barriers to Exercise in Nursing and Medical Students. Journal of Advanced Nursing, 73, 917-929. https://doi.org/10.1111/jan.13181
[6]
Bürkner, P.-C., & Vuorre, M. (2019). Ordinal Regression Models in Psychology: A Tutorial. Advances in Methods and Practices in Psychological Science, 2, 77-101. https://doi.org/10.1177/2515245918823199
[7]
Cerin, E., Leslie, E., Sugiyama, T., & Owen, N. (2010). Perceived Barriers to Leisure-Time Physical Activity in Adults: An Ecological Perspective. Journal of Physical Activity and Health, 7, 451-459. https://doi.org/10.1123/jpah.7.4.451
[8]
Conway, J., Tsourtos, G., & Lawn, S. (2017). The Barriers and Facilitators That Indigenous Health Workers Experience in Their Workplace and Communities in Providing Self-Management Support: A Multiple Case Study. BMC Health Services Research, 17, Article No. 319. https://doi.org/10.1186/s12913-017-2265-5
[9]
Darr, A., Astin, F., & Atkin, K. (2008). Causal Attributions, Lifestyle Change, and Coronary Heart Disease: Illness Beliefs of Patients of South Asian and European Origin Living in the United Kingdom. Heart & Lung, 37, 91-104. https://doi.org/10.1016/j.hrtlng.2007.03.004
[10]
De Knop, P., Theeboom, M., Wittock, H., & De Martelaer, K. (1996). Implications of Islam on Muslim Girls’ Sport Participation in Western Europe. Literature Review and Policy Recommendations for Sport Promotion. Sport, Education and Society, 1, 147-164. https://doi.org/10.1080/1357332960010202
[11]
Dhawan, J., & Bray, C. L. (1997). Asian Indians, Coronary Artery Disease, and Physical Exercise. Heart, 78, 550-554.
[12]
Edmunds, S., Hurst, L., & Harvey, K. (2013). Physical Activity Barriers in the Workplace: An Exploration of Factors Contributing to Non-Participation in a UK Workplace Physical Activity Intervention. International Journal of Workplace Health Management, 6, 227-240. https://doi.org/10.1108/IJWHM-11-2010-0040
[13]
Farooqi, A., Nagra, D., Edgar, T., & Khunti, K. (2000). Attitudes to Lifestyle Risk Factors for Coronary Heart Disease amongst South Asians in Leicester: A Focus Group Study. Family Practice, 17, 293-297. https://doi.org/10.1093/fampra/17.4.293
[14]
Gabry, J., Simpson, D., Vehtari, A., Betancourt, M., & Gelman, A. (2019). Visualization in Bayesian Workflow. Journal of the Royal Statistical Society: Series A (Statistics in Society), 182, 389-402. https://doi.org/10.1111/rssa.12378
[15]
Gelman, A., Goodrich, B., Gabry, J., & Vehtari, A. (2019). R-Squared for Bayesian Regression Models. The American Statistician, 73, 307-309. https://doi.org/10.1080/00031305.2018.1549100
[16]
Guthold, R., Stevens, G. A., Riley, L. M., & Bull, F. C. (2018). Worldwide Trends in Insufficient Physical Activity from 2001 to 2016: A Pooled Analysis of 358 Population-Based Surveys with 1.9 Million Participants. The Lancet Global Health, 6, e1077-e1086. https://doi.org/10.1016/S2214-109X(18)30357-7
[17]
Guthold, R., Stevens, G. A., Riley, L. M., & Bull, F. C. (2020). Global Trends in Insufficient Physical Activity among Adolescents: A Pooled Analysis of 298 Population-Based Surveys with 1.6 Million Participants. The Lancet Child & Adolescent Health, 4, 23-35. https://doi.org/10.1016/S2352-4642(19)30323-2
[18]
Hallal, P. C., Andersen, L. B., Bull, F. C., Guthold, R., Haskell, W., Ekelund, U., & Group, L. P. A. S. W. (2012). Global Physical Activity Levels: Surveillance Progress, Pitfalls, and Prospects. The Lancet, 380, 247-257. https://doi.org/10.1016/S0140-6736(12)60646-1
[19]
Hayes, L., White, M., Unwin, N., Bhopal, R., Fischbacher, C., Harland, J., & Alberti, K. (2002). Patterns of Physical Activity and Relationship with Risk Markers for Cardiovascular Disease and Diabetes in Indian, Pakistani, Bangladeshi and European Adults in a UK Population. Journal of Public Health, 24, 170-178. https://doi.org/10.1093/pubmed/24.3.170
[20]
Hosper, K., Klazinga, N. S., & Stronks, K. (2007). Acculturation Does Not Necessarily Lead to Increased Physical Activity during Leisure Time: A Cross-Sectional Study among Turkish Young People in the Netherlands. BMC Public Health, 7, Article No. 230. https://doi.org/10.1186/1471-2458-7-230
[21]
Kelly, S., Martin, S., Kuhn, I., Cowan, A., Brayne, C., & Lafortune, L. (2016). Barriers and Facilitators to the Uptake and Maintenance of Healthy Behaviours by People at Mid-Life: A Rapid Systematic Review. PLoS ONE, 11, e0145074. https://doi.org/10.1371/journal.pone.0145074
[22]
Kruger, J., & Kohl III, H. W. (2008). Prevalence of Regular Physical Activity among Adults—United States, 2001 and 2005. JAMA, 299, 30-32. https://doi.org/10.1001/jama.299.1.30
[23]
Lawton, J., Ahmad, N., Hanna, L., Douglas, M., & Hallowell, N. (2006). “I Can’t Do Any Serious Exercise”: Barriers to Physical Activity amongst People of Pakistani and Indian Origin with Type 2 Diabetes. Health Education Research, 21, 43-54. https://doi.org/10.1093/her/cyh042
[24]
Lear, S. A., Humphries, K. H., Hage-Moussa, S., Chockalingam, A., & Mancini, G. J. (2009). Immigration Presents a Potential Increased Risk for Atherosclerosis. Atherosclerosis, 205, 584-589. https://doi.org/10.1016/j.atherosclerosis.2008.12.037
[25]
Liddell, T. M., & Kruschke, J. K. (2018). Analyzing Ordinal Data with Metric Models: What Could Possibly Go Wrong? Journal of Experimental Social Psychology, 79, 328-348. https://doi.org/10.1016/j.jesp.2018.08.009
[26]
Massahikhaleghi, P., Tehrani-Banihashemi, A., Saeedzai, S. A., Hossaini, S. M., Hamedi, S. A., Moradi-Lakeh, M., Naghavi, M., Murray, C. J., & Mokdad, A. H. (2018). Burden of Diseases and Injuries in Afghanistan, 1990-2016: Findings from the Global Burden of Disease 2016 Study. Archives of Iranian Medicine (AIM), 21, 324-334.
[27]
McGuire, A. M. (2015). Benefits and Barriers to Exercise in Midlife Women Undertaking a Web-Based Multi-Modal Lifestyle Intervention for the Primary Prevention of Chronic Disease. Brisbane: Queensland University of Technology.
[28]
Nakamura, Y. (2002). Beyond the Hijab: Female Muslims and Physical Activity. Women in Sport and Physical Activity Journal, 11, 21-48. https://doi.org/10.1123/wspaj.11.2.21
[29]
O’Donovan, G., Hillsdon, M., Ukoumunne, O. C., Stamatakis, E., & Hamer, M. (2013). Objectively Measured Physical Activity, Cardiorespiratory Fitness and Cardiometabolic Risk Factors in the Health Survey for England. Preventive Medicine, 57, 201-205. https://doi.org/10.1016/j.ypmed.2013.05.022
[30]
Office for National Statistics (2013). Immigration Patterns of Non-UK Born Populations in England and Wales in 2011.
[31]
Office for National Statistics (2019). Population of the UK by Country of Birth and Nationality. London: Office for National Statistics. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/ internationalmigration/datasets/populationoftheunitedkingdombycountryofbirthandnationality
[32]
Rathanaswami, K., Bengoechea, E. G., & Bush, P. L. (2016). Physical Activity in First Generation South Asian Women Living in Canada: Barriers and Facilitators to Participation. Women in Sport and Physical Activity Journal, 24, 110-119. https://doi.org/10.1123/wspaj.2015-0019
[33]
Santos, I., Ball, K., Crawford, D., & Teixeira, P. J. (2016). Motivation and Barriers for Leisure-Time Physical Activity in Socioeconomically Disadvantaged Women. PLoS ONE, 11, e0147735. https://doi.org/10.1371/journal.pone.0147735
[34]
Siddiqui, F. R., Bhatti, M. A., & Shahid, A. (2008). Knowledge, Attitudes and Practices to Lifestyle Risk Factors for Coronary Heart Disease (CHD) and Diabetes amongst South Asians in North Kirklees, England—A Focus Group Study. Pakistan Armed Forces Medical Journal, 58, 304-311.
[35]
Sriskantharajah, J., & Kai, J. (2007). Promoting Physical Activity among South Asian Women with Coronary Heart Disease and Diabetes: What Might Help? Family Practice, 24, 71-76. https://doi.org/10.1093/fampra/cml066
[36]
Talaei, M., Rabiei, K., Talaei, Z., Amiri, N., Zolfaghari, B., Kabiri, P., & Sarrafzadegan, N. (2013). Physical Activity, Sex, and Socioeconomic Status: A Population-Based Study. ARYA Atherosclerosis, 9, 51-60.
[37]
Taylor, T., & Toohey, K. (2001). Behind the Veil: Exploring the Recreation Needs of Muslim Women. Leisure/Loisir, 26, 85-105. https://doi.org/10.1080/14927713.2001.9649930
[38]
Tinker, A., Molloy, L., Monks, I., Pennells, L., Russell, E., & Haines, E. (2017). The Benefits and Barriers of Exercise for the Physical Health of Older Women. Journal of Aging, Research and Clinical Practice, 6, 73-79.
[39]
Trost, S. G., Owen, N., Bauman, A. E., Sallis, J. F., & Brown, W. (2002). Correlates of Adults’ Participation in Physical Activity: Review and Update. Medicine & Science in Sports & Exercise, 34, 1996-2001. https://doi.org/10.1097/00005768-200212000-00020
[40]
Vehtari, A., Gelman, A., & Gabry, J. (2017). Practical Bayesian Model Evaluation Using Leave-One-Out Cross-Validation and WAIC. Statistics and Computing, 27, 1413-1432. https://doi.org/10.1007/s11222-016-9696-4
[41]
Walseth, K., & Fasting, K. (2003). Islam’s View on Physical Activity and Sport: Egyptian Women Interpreting Islam. International Review for the Sociology of Sport, 38, 45-60. https://doi.org/10.1177/10126902030381003
[42]
Wang, L., Kong, L., Wu, F., Bai, Y., & Burton, R. (2005). Preventing Chronic Diseases in China. The Lancet, 366, 1821-1824. https://doi.org/10.1016/S0140-6736(05)67344-8
[43]
Williams, E. D., Stamatakis, E., Chandola, T., & Hamer, M. (2011). Physical Activity Behaviour and Coronary Heart Disease Mortality among South Asian People in the UK: An Observational Longitudinal Study. Heart, 97, 655-659. https://doi.org/10.1136/hrt.2010.201012
[44]
Withall, J., Jago, R., & Fox, K. R. (2011). Why Some Do but Most Don’t. Barriers and Enablers to Engaging Low-Income Groups in Physical Activity Programmes: A Mixed Methods Study. BMC Public Health, 11, Article No. 507. https://doi.org/10.1186/1471-2458-11-507
[45]
World Health Organization (2018). Physical Activity, Key Facts. http://www.who.int/News-Room/Fact-Sheets/Detail/Physical-Activity
[46]
World Health Organization, Regional Office for the Eastern Mediterranean (2015). Country Factsheet Insufficient Physical Activity: Afghanistan. WHO-EM/HED/126/E. WHO IRIS. https://apps.who.int/iris/handle/10665/204240
[47]
Zaman, H. (1997). Islam, Well-Being and Physical Activity: Perceptions of Muslim Young Women. In G. Clarke, & B. Humberstone (Eds.), Researching Women and Sport (pp. 50-67). London: Palgrave Macmillan. https://doi.org/10.1007/978-1-349-25317-3_4
