Abstract
BackgroundThe proportion of obese women is nearly twice the proportion of obese men in Barbados, and physical inactivity may be a partial determinant. Using qualitative interviews and ‘semi-structured’ participant observation, the aim of this study was to identify modifiable barriers to physical activity and to explore the factors that facilitate physical activity amongst overweight and obese women in this low-resourced setting.MethodsSeventeen women aged 25 to 35 years with a BMI ≥25, purposefully sampled from a population-based cross-sectional study conducted in Barbados, were recruited in 2014 to participate in in-depth semi-structured interviews. Twelve of these women participated in one or more additional participant observation sessions in which the researcher joined and observed a routine activity chosen by the participant. More than 50 hours of participant observation data collection were accumulated and documented in field notes. Thematic content analysis was performed on transcribed interviews and field notes using the software Dedoose.ResultsSocial, structural and individual barriers to physical activity were identified. Social factors related to gender norms and expectations. Women tended to be active with their female friends rather than partners or male peers, and reported peer support but also alienation. Being active also competed with family responsibilities and expectations. Structural barriers included few opportunities for active commuting, limited indoor space for exercise in the home, and low perceived access to convenient and affordable exercise classes. Several successful strategies associated with sustained activity were observed, including walking and highly social, low-cost exercise groups. Individual barriers related to healthy living strategies included perceptions about chronic disease and viewing physical activity as a possible strategy for desired weight loss but less effective than dieting.ConclusionsIt is important to understand why women face barriers to physical activity, particularly in low-resourced settings, and to investigate how this could be addressed. This study highlights the role that gender norms and health beliefs play in shaping experiences of physical activity. In addition, structural barriers reflect a mix of resource-scarce and resource-rich factors which are likely to be seen in a wide variety of developing contexts.
Highlights
The proportion of obese women is nearly twice the proportion of obese men in Barbados, and physical inactivity may be a partial determinant
A recent systematic review of social determinants of diabetes risk factors and control found that women across the Caribbean region were more likely to have diabetes, be obese and less physically active than men [4]
Based on GBD 2010 results, having a BMI ≥ 25 is the single greatest risk factor associated with disease burden in Barbados, contributing to over 11 % of total disability-adjusted life years (DALYs) [5]
Summary
The proportion of obese women is nearly twice the proportion of obese men in Barbados, and physical inactivity may be a partial determinant. A recent systematic review of social determinants of diabetes risk factors and control found that women across the Caribbean region were more likely to have diabetes, be obese and less physically active than men [4]. According to the Health of the Nation Study, a population-based cross-sectional study conducted from 2012–2013, 74.2 % (70.3-77.7 %) of women aged 25 and over are overweight or obese compared to 57.5 % (51.2-63.7 %) of men [6]. The Health of the Nation study reports prevalence of central obesity, which is more strongly associated with diseases such as diabetes and cardiovascular conditions. Based on objectively measured physical activity levels reported as part of the Health of the Nation study, 90.5 % (83.3-94.7 %) of women aged 25–54 are physically inactive according to WHO minimum recommendations, compared to 58.9 % (48.4-68.7 %) of men aged 25-54[6]. There have been numerous studies on the barriers and facilitators to physical activity among Afro-Caribbean populations in the Diaspora [22,23,24] but research about physical activity in the Caribbean is limited [25,26,27]
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