Socioecological Factors Associated with an Urban Exercise Prescription Program for Under-Resourced Women: A Mixed Methods Community-Engaged Research Project.

Sarah M Camhi,Philip J Troped,Julianna Andrews,Laura L Hayman,Ana Cristina Lindsay,Gifty Debordes-Jackson,Julie Wright

doi:10.3390/ijerph18168726

Abstract

One strategy to promote physical activity (PA) is for health care providers to give exercise prescriptions (ExRx) that refer to community-based facilities. However, facilitators and barriers specific to urban programs in the US for under-resourced women are unknown. Thus the purpose of this formative research was to explore ExRx barriers and facilitators specific to US under-resourced women to inform future intervention targets and strategies. This mixed-methods community-engaged research was conducted in partnership with an urban women’s only wellness center that exchanged ExRx for free access (1–3 months). Qualitative semi-structured interviews and validated quantitative questionnaires (SF-12, International Physical Activity Questionnaire, Physical Activity Self-Efficacy, Physical Activity Stage of Change, and Barriers to Physical Activity, Social Support for Exercise, and Confusion, Hubbub, and Order Scale) were administered by phone and guided by the socio-ecological model. ExRx utilization was defined as number visits/week divided by membership duration. Means and percentages were compared between ≥1 visit/week vs. <1 visit/week with t-tests and chi-square, respectively. Women (n = 30) were 74% Black, 21–78 years of age, 50% had ≤ high school diploma, and 69% had household incomes ≤45,000/year. Women with ≥1 visit/week (n = 10; 33%) reported more education and higher daily activity, motivation, number of family CVD risk factors and family history of dyslipidemia compared with <1 visit/week. Facilitators among women with ≥1 visit/week were “readiness” and “right timing” for ExRx utilization. Barriers among women with <1 visit/week (n = 20; 67%) were “mismatched expectations” and “competing priorities”. Common themes among all women were “sense of community” and “ease of location”. ExRx utilization at an US urban wellness center may be dependent on a combination of multi-level factors including motivation, confidence, peer support, location and ease of access in under-sourced women. Additional resources may be needed to address mental and/or physical health status in additional to physical activity specific programming.

Highlights

Obesity is increasing in the United States (US) with projections that 40–50% of adults will be obese by 2030 [1]
250 women were contacted from the wellness center which resulted in n = 48 women screened to determine eligibility
Women with ≥1 visit/week reported more family history of dyslipidemia (p = 0.04) and the number of cardiovascular disease risk factors compared to women with

Summary

Introduction

Obesity is increasing in the United States (US) with projections that 40–50% of adults will be obese by 2030 [1]. Obese adults are more likely to have abnormal cardiovascular disease (CVD) risk factors [2], which increases their risk for CVD mortality and morbidity [3]. It is well documented that increasing physical activity (PA) can improve obesity.

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Discussion

Conclusion