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Optimizing older adults’ home space to enhance physical activity and minimize sedentary behaviour / NAUREEN MEGHANI
Swansea University Author: NAUREEN MEGHANI
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Copyright: The Author, Naureen Akber Ali Meghani, 2024
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DOI (Published version): 10.23889/SUThesis.69221
Abstract
Many older adults (OAs) are sedentary and do not participate in adequate levels of physical activity (PA) which would improve body function and reduce frailty, both of which are important for OA’s health and well-being. However, the situation is even worse with ethnically diverse OAs, considering th...
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Swansea University, Wales, UK
2024
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| Institution: | Swansea University |
| Degree level: | Doctoral |
| Degree name: | Ph.D |
| Supervisor: | Hudson, J., Stratton, G., and Mullins, J. |
| URI: | https://cronfa.swan.ac.uk/Record/cronfa69221 |
| Abstract: |
Many older adults (OAs) are sedentary and do not participate in adequate levels of physical activity (PA) which would improve body function and reduce frailty, both of which are important for OA’s health and well-being. However, the situation is even worse with ethnically diverse OAs, considering the high burden of chronic disease in this group. Therefore, PA and SB research with this group is particularly important. Ethnically diverse groups of OAs may have complex and different perspectives on healthcare, academia and research compared with other groups within the OA population. Therefore, cultural and social elements need specific consideration (such as privacy, lack of motivation, language, literacy and care giving responsibilities and location) as they might affect recruitment and retention of OAs from underrepresented groups within the population. Evidence has shown that an increasingly diverse OA population is observed in the United Kingdom (UK), partly influenced by present immigration and population trends, which is associated with complexity in terms of language, socioeconomic level, and the acculturation and immigration experience. Therefore, it is important to increase the representation of this group in research. In this regard the present research focuses on ethnically diverse OAs who are aged ≥65 years to improve their activity and reduce their SB.Given that OAs spend a significant time at home being sedentary, increased knowledge of the factors related to this behaviour in the home environment would present significant insight for intervention planning. A key element of any intervention developed with this knowledge is the assessment of its feasibility and acceptability with this population group to determine any required modifications in a subsequent larger effectiveness trial. In addition, exploring the perspectives of stakeholders will direct the implementation of this intervention in practice or in a real-world setting. Therefore, the primary aim of this research thesis was to create and test the feasibility and acceptability of an intervention to optimise OAs’ home space to increase their activity and reduce their SB.Study 1 investigated perceptions of ethnically diverse OAs regarding their activity and sedentary patterns within the home setting using the socio-ecological model (SEM) as a theoretical framework. Using purposive sampling, 33 in-depth interviews and 5 focus group discussions were carried out. Reflexive thematic analysis was applied to generate themes from the data which were subsequently interpreted using the constructs and proposals of the SEM. The study findings showed that PA and SB of OAs are influenced by different levels of the SEM. These include: 1) Individual level such as insight, attitude and motivation behind PA and SB; 2) Interpersonal level such as relatives’ and friends’ support to be more active and less sedentary within the home; 3) Organisational level such as healthcare organisations promoting PA initiatives; 4) Community level factors such as social groups, and the importance of culture-sensitive group activities; 5) Physical Environment level factors such as home space characteristics (e.g., available space and stairs), and, 6) Policy level factors including lockdown constraints impacting PA and SB at home. These findings provide a suitable underpinning to design and execute a multi-component person-centred intervention for community dwelling ethnically diverse OAs in Study 2.In this study, a multi-method approach using semi-structured interviews and self-reported measures (n = 23) was employed to explore participants’ experiences, and the effect of this intervention on activity and sedentary patterns (the Home space intervention). SEM and the habit formation model guided this intervention (that included a health coaching session, information pamphlet, reminder messages and wearable activity tracker; WAT that emitted vibrations and sound alerts after an hour of sitting designed by the research team). Study findings showed improvements in PA and reductions in sedentary time, improved scores in mental well-being, self-efficacy, PA habits and reductions in SB habit index after the intervention. The participants viewed the intervention as acceptable and expressed satisfaction with the intervention components and the research. However, study participants suggested some modifications in the WAT size and functionality to make it more user- friendly. These results could have a substantial effect on public health by showing that sedentary ethnically diverse OAs can gain benefits from even small increases in PA. Therefore, shifting from a sedentary lifestyle could have a significant effect for these individuals.Given the established feasibility of the 12-week intervention in study 2, the thesis extends to Study 3 to determine the perceptions of stakeholders regarding the transfer of the intervention into real world settings using the PIET-T (Population, Intervention, Environment, Transfer, model of transferability). Exploratory qualitative research was undertaken using purposive sampling and in-depth interviews (IDIs) to recruit 10 stakeholders from different local organisations that are involved in improving OAs' activity and/or health and well-being and therefore could implement the Home space intervention as part of their work. Reflexive thematic analysis was used to analyse the qualitative data which were interpreted using the PIET-T model. The intervention was found to be appealing and feasible, and most of the stakeholders felt their organisations could play a role in supporting it. Regardless, they highlighted the need to consider cultural equalities (translation of the intervention content into native languages), timely identification of funding and delivery opportunities to increase the possibility of its successful implementation along, working in partnership with non-governmental (NGOs) and community organisations, involvement of healthcare professionals and health trainers, training of staff, and, they identified various facilitators and barriers (e.g., lack of resources, team instability, community engagement, incentives) that they felt would help in the transferability of the intervention into real-world settings.This novel research attempts to address the low amount of PA and high sedentary level among ethnically diverse OAs. The results of the study indicate that altering PA and SB in the physical environment of the home is a complex process that is impacted by several SEM levels. The multi- component intervention developed from these findings was acceptable to a group of ethnically diverse OAs and led to improvements in their PA and a reduction in their sedentary time. If supported by a future effectiveness trial, this could have a substantial effect on public health as sedentary OAs can gain health benefits from even small increases in PA. Therefore, performing LPA to shift from a sedentary lifestyle has a significant effect on OAs. There is, however, a lack of transferability research in the domain of PA and SB with ethnically diverse OAs. This research highlights the importance of collaborating with stakeholders in transferring the intervention into real-world settings to promote PA and minimize SB among ethnically diverse OAs. The study findings inform the transferability of the intervention as well as increasing awareness in the wider research community of crucial intervention elements, obstacles, and enablers for implementing public health interventions into real- world contexts. |
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| Item Description: |
A selection of content is redacted or is partially redacted from this thesis to protect sensitive and personal information. |
| Keywords: |
Sedentary behaviour, physical activity and older adults |
| College: |
Faculty of Science and Engineering |
| Funders: |
ESRC |