Abstract
Aims: A community-based multi-component intervention (increasing awareness of the importance of physical activity in chronic illness management through reading comic books, training regarding warm-up stretching exercises, identifying facilitators and barriers to exercise through photosharing, supporting self-reflection and development of action plans) was developed to promote physical activity (PA) among patients with diabetes and hypertension. This study aimed to evaluate the efficacy of this intervention on health behaviour (walking) and health outcomes. Design: A non-randomized controlled trial with waitlisted control and pre- and post-measures. Setting: Community centres for the elderly. Participants: A total of 204 older adults with diabetes and/or hypertension were recruited. They were assigned to either the intervention group (IG) or waitlisted to the control group (CG). Intervention: Under the supervision of a nurse, six weekly group meetings were arranged in community centres for the elderly in which the participants freely exchanged their views regarding the barriers and facilitators of regular physical activity. Participants were encouraged to take photos in their neighbourhood or at home and brought these photos to share at the group meetings. The photos showed both the barriers and the facilitators to PA. In the last meeting, each participant worked out a plan to perform PA in the coming four weeks. Measures: PA referred to the number of steps taken per day and it was measured by a Garmin Accelerometer at baseline, Week 6 and Week 10. Other measures included the nine-item Self-Efficacy Scale for Exercise–Chinese version (SEE-C), and the 23-item Chinese Barriers to Exercise Scale and Senior Fitness Tests. Generalised estimating equations (GEE) models compared the outcomes over time between IG and CG. Results: A statistically significant difference in the changes in the average number of steps taken daily between the two groups at Week 10 (mean difference = 965.4; 95% confidence interval: 92.2, 1838.6, p = 0.030) was observed, although the difference at Week 6 was non-significant (mean difference = 777.6; 95% confidence interval: −35.3, 1590.5, p = 0.061). IG participants also showed significant improvements in lower body strength (mean difference = 0.967; 95% confidence interval: 0.029, 1.904, p = 0.043) and lower limb flexibility (mean difference = 2.068; 95% confidence interval: 0.404, 3.731, p = 0.015) at Week 10 compared to CG participants. Conclusion: This multi-component intervention improved the participants’ physical activity level and physical fitness, particularly in lower limb flexibility and body strength.
Highlights
Photovoice, a health literacy tool, has received growing attention in health promotion and health education since its development in the mid-1990s [1]
The innovative aspect of this study is the incorporation of the concept of photovoice in an intervention as we believe that the participants would achieve personal growth and make decisions regarding their behaviour after their participation in the intervention
A total of 252 participants were screened for eligibility
Summary
Photovoice, a health literacy tool, has received growing attention in health promotion and health education since its development in the mid-1990s [1]. We acknowledge photovoice as a powerful tool to empower individuals by giving them opportunities to talk about their individual problems (for example, having certain barriers to physical activities) and find ways to solve these problems Through this process, empowerment occurred and this will support individual growth (for example, participants may consider making a change in their behaviour). We deliberately formulated a six-week community-based health promotion programme (or the intervention) with photovoice as one of the components in the intervention This intervention did not solely use photos and group discussion, it comprised other components such as understanding the importance of physical activity in chronic illness management through the reading of comic books and developing action plans for the four weeks in the neighbourhood. The innovative aspect of this study is the incorporation of the concept of photovoice in an intervention as we believe that the participants would achieve personal growth and make decisions regarding their behaviour after their participation in the intervention
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