Exploring equity in primary-care-based physical activity interventions using PROGRESS-Plus: a systematic review and evidence synthesis.

S Attwood,S Sutton,E Van Sluijs

doi:10.1186/s12966-016-0384-8

Abstract

BackgroundLittle is known about equity effects in primary care based physical activity interventions. This review explored whether differences in intervention effects are evident across indicators of social disadvantage, specified under the acronym PROGRESS-Plus (place of residence, race/ethnicity, occupation, gender, religion, education, social capital, socioeconomic status, plus age, disability and sexual orientation).MethodsSix bibliographic databases were systematically searched for randomised controlled trials (RCTs) of physical activity interventions conducted in primary care. Harvest plots were used to synthesize findings from RCTs reporting subgroup or interaction analyses examining differences in intervention effects across levels of at least one PROGRESS-Plus factor.ResultsThe search yielded 9052 articles, from which 173 eligible RCTs were identified. Despite PROGRESS-Plus factors being commonly measured (N = 171 RCTs), differential effect analyses were infrequently reported (N = 24 RCTs). Where reported, results of equity analyses suggest no differences in effect across levels or categories of place of residence (N = 1RCT), race (N = 4 RCTs), education (N = 3 RCTs), socioeconomic status (N = 3 RCTs), age (N = 16 RCTs) or disability (N = 2 RCTs). Mixed findings were observed for gender (N = 22 RCTs), with some interventions showing greater effect in men than women and others vice versa. Three RCTs examined indicators of social capital, with larger post-intervention differences in physical activity levels between trial arms found in those with higher baseline social support for exercise in one trial only. No RCTs examined differential effects by participant occupation, religion or sexual orientation.ConclusionThe majority of RCTs of physical activity interventions in primary care record sufficient information on PROGRESS-Plus factors to allow differential effects to be studied. However, very few actually report details of relevant analyses to determine which population subgroups may stand to benefit or be further disadvantaged by intervention efforts.Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-016-0384-8) contains supplementary material, which is available to authorized users.

Highlights

Little is known about equity effects in primary care based physical activity interventions
Search strategy & inclusion criteria Systematic searches were conducted in August 2014 and updated in March 2016 to identify published articles reporting details of randomised controlled trials (RCTs) of physical activity interventions in primary care
Our results indicate that only a small number of RCTs report relevant analyses that allow us to draw conclusions regarding the differential effectiveness of physical activity interventions in this context

Summary

Introduction

Little is known about equity effects in primary care based physical activity interventions. Tackling health inequities, defined as systematic differences in health between groups in society experiencing different levels of social disadvantage [1], remains a priority for those attempting to improve population health through intervention. From the perspective of health inequities, engaging in fewer beneficial health behaviours, including physical activity, is one pathway through which social disadvantage may increase the risk of disease [3]. Existing evidence suggests that groups in society with less access to power, wealth or prestige may be less likely to engage in sufficient physical activity to benefit their health [4]. Intervening in specific population subgroups may not prove the most effective approach to reducing health risks associated with inactive lifestyles [12]

Methods

Results

Discussion

Conclusion