Beliefs about physical activity--focus group results of Chinese community elderly in Seattle and Taipei

Physical Activity and Breast Cancer Prevention Among Chinese American Women: A Qualitative Descriptive Study

Physical inactivity is a modifiable behavioral risk factor for breast cancer. Chinese American women have an increased breast cancer incidence and a low prevalence of meeting physical activity (PA) recommendations, yet little is known about their knowledge and experience regarding PA and breast cancer prevention. Given the significant cultural differences between Eastern and Western societies, effective interventions to promote PA among Chinese American women require understanding their knowledge levels regarding PA in breast cancer prevention and their PA experiences through a cultural lens. This qualitative descriptive study used virtual semi-structured individual interviews to explore Chinese American women's knowledge and perception of PA, their understanding of the role of PA in breast cancer prevention, and influence of culture and acculturation on PA experience. Twenty-one Chinese American women residing in eight states were interviewed. Using thematic analysis, four themes emerged: A limited appreciation of the preventability of breast cancer, variability in PA perception, Chinese culture norms and lifestyles influencing PA behavior, and the influence of the process of acculturation on PA behavior. Chinese American women had a limited understanding of PA in breast cancer prevention. Chinese culture, lifestyles, and traditional Chinese medicine positively and negatively influence Chinese American women's PA behaviors. When exposed to American culture, Chinese American women tended to adopt new PA behaviors, including increasing leisure-time PA while decreasing occupation- and transportation-related PA. Interventions to increase PA and reduce breast cancer risk among Chinese American women should address cultural factors and acculturation along with education and behavioral change strategies.

The Role of Family Social Networks in Cardiovascular Health Behaviors Among Asian Americans, Native Hawaiians, and Pacific Islanders

Asian American, Native Hawaiians, and Other Pacific Islander (AANHPI) populations experience significant disparities in cardiovascular health. AANHPI populations also have strong, family-centered social relationships and networks. Since social networks may influence health behaviors, this review aimed to summarize research on the relationship between family social networks and cardiovascular health behaviors among AANHPI individuals. Current evidence suggests that family social network structures may play a particularly important role in smoking, dietary pattern, and physical activity behaviors among AANHPI individuals. Family networks may hinder or promote healthy behaviors through several social network mechanisms including social support, social influence, and social control. These effects vary across different AANHPI subgroups. Recommendations for future research on the role of social networks in health behaviors among AANHPI individuals are provided. Drawing on methodological advances and interventions that leverage social networks in AANHPI populations may be an avenue to improve health and reduce disparities.

Comparison of Health Care Expenditures Among U.S. Older Adults With Pain Who Reported Frequent Exercise Versus Nonfrequent Exercise

This cross-sectional study included a nationally representative sample of U.S. adults aged ≥50 years with self-reported pain in the past 4 weeks from the 2018 Medical Expenditure Panel Survey. Adjusted linear regression analyses accounted for the complex survey design and assessed differences in several types of annual health care expenditures between individuals who reported frequent exercise (≥30 min of moderate-vigorous intensity physical activity ≥5 times per week) and those who did not. Approximately 23,940,144 of 56,979,267 older U.S. adults with pain reported frequent exercise. In adjusted analyses, individuals who reported frequent exercise had 15% lower annual prescription medication expenditures compared with those who did not report frequent exercise (p = .007). There were no statistical differences between frequent exercise status for other health care expenditure types (p > .05). In conclusion, adjusted annual prescription medication expenditures were 15% lower among older U.S. adults with pain who reported frequent exercise versus those who did not.

Beliefs and motivation regarding physical activity among older adults in Germany: results of a qualitative study

Purpose: As the proportion of older adults in Germany continues to grow, so does the need for physical activity as a strategy for health promotion. The purpose of this study is to gain insights into the belief system underlying older adults' physical activity and its interplay with motivation by integrating Theory of Planned Behaviour and Self-Determination Theory.Methods: We conducted 20 semi-structured interviews with residents of Germany who were 65 years of age or older. Transcripts of interviews were analysed with a coding frame of deductive main categories and inductive subcategories.Results: Part of our results is a typology that divides our sample into four groups based on the intensity and perceived sufficiency of their physical activity. These groups mainly differ in their intrinsic vs. extrinsic motivation and how they deal with barriers to physical activity, i.e., control beliefs.Conclusion: Messages to promote physical activity should be tailored regarding older adults' varying beliefs and motivation. To overcome barriers, intrinsic motivation plays a crucial role. Intrinsic motivation is closely linked to activities that are joyful and satisfy basic psychological needs. Moreover, it is important for older adults to be able to adjust their activities to age-related physical limitations and chronic diseases.

The Dunedin dementia risk awareness project: pilot study in older adults

AIMS

The USA and UK governmental and academic agencies suggest that up to 35% of dementia cases are preventable. We canvassed dementia risk and protective factor awareness among New Zealand older adults to inform the design of a larger survey.

METHOD

The modified Lifestyle for Brain Health scale quantifying dementia risk was introduced to a sample of 304 eligible self-selected participants.

RESULTS

Two hundred and sixteen older adults (≥50 years), with mean ± standard deviation age 65.5 ± 11.4 years (50-93 years), completed the survey (71% response rate). Respondents were mostly women (n = 172, 80%), European (n = 207, 96%), and well educated (n = 100, 46%, with a tertiary qualification; including n = 17, 8%, with a postgraduate qualification). Around half of the participants felt that they were at a future risk of living with dementia (n = 101, 47%), and the majority felt that this would change their lives significantly (n = 205, 95%), that lifestyle changes would reduce their risk (n = 197, 91%), and that they could make the necessary changes (n = 189, 88%) and wished to start changes soon (n = 160, 74%). Only 4 of 14 modifiable risk or protective factors for dementia were adequately identified by the participants: physical exercise (81%), depression (76%), brain exercises (75%), and social isolation (83%). Social isolation was the commonly cited risk factor for dementia, while physical exercise was the commonly cited protective factor. Three clusters of brain health literacy were identified: psychosocial, medical, and modifiable.

CONCLUSION

The older adults in our study are not adequately knowledgeable about dementia risk and protective factors. However, they report optimism about modifying risks through lifestyle interventions.

Physical Activity Among Foreign-Born Older Adults in Canada: A Mixed-Method Study Conducted in Five Languages

Foreign-born older adults (FBOAs) are at risk for negative health transitions in Canada. Physical activity (PA) enhances health, yet we know very little about the PA habits of FBOAs in Canada. We conducted a mixed-method study in English, Cantonese, Mandarin, Punjabi, and Hindi, with 49 South Asian and Chinese FBOAs in Vancouver, Canada. In total, 49 participants completed surveys; of these 49, 46 wore accelerometers and 18 completed in-depth interviews. Participants’ mean daily step count was 7,876 (women: 8,172, men: 7,164, Chinese: 8,291, and South Asian: 7,196). The bulk of their time is spent in light and sedentary activities. PA is principally acquired through walking for errands and work performed in and around the home. This study challenges the assumption that FBOAs are less active than their nonimmigrant peers and confirms the key role of “nonexercise” and low activity, rather than moderate to vigorous, in older adults’ PA acquisition.

Older Ethnic Minority Women's Perceptions of Stroke Prevention and Walking

OBJECTIVE

To inform the development of a tailored behavioral stroke risk reduction intervention for ethnic minority seniors, we sought to explore gender differences in perceptions of stroke prevention and physical activity (walking).

METHODS

In collaboration with community-based organizations, we conducted 12 mixed-gender focus groups of African American, Latino, Chinese, and Korean seniors aged 60 years and older with a history of hypertension (89 women and 42 men). Transcripts were coded and recurring topics compared by gender.

RESULTS

Women expressed beliefs that differed from men in 4 topic areas: 1) stroke-related interest, 2) barriers to walking, 3) facilitators to walking, and 4) health behavior change attitudes. Compared with men, women were more interested in their role in response to a stroke and post-stroke care. Women described walking as an acceptable form of exercise, but cited neighborhood safety and pain as walking barriers. Fear of nursing home placement and weight loss were identified as walking facilitators. Women were more prone than men to express active/control attitudes toward health behavior change.

CONCLUSIONS

Older ethnic minority women, a high-risk population for stroke, may be more receptive to behavioral interventions that address the gender-specific themes identified by this study.

Cultural influences on exercise participation and fall prevention: a systematic review and narrative synthesis

PURPOSE

We aim to provide a systematic review of qualitative research evidence relevant to the experiences and perceptions of program providers and participants from culturally and linguistically diverse (CALD) backgrounds regarding (i) exercise and (ii) fall prevention programs for older people.

METHOD

Using a narrative synthesis approach, we reviewed published journal articles reporting qualitative data. Electronic and manual literature searches were conducted to identify 19 publications that met the inclusion criteria. Of these, 16 discussed exercise and three focused on broader fall prevention programs. However, no studies were identified that explored the perspective of the program providers.

RESULTS

An overarching theme emerged identifying the influence of cultural values and perceptions on program participation. Also, identified were motivational, social and environmental influences.

CONCLUSION

Exercise and fall prevention interventions need to be culturally appropriate and utilise the positive influences of social support, especially from physicians and family. While these findings can be used to inform the delivery of programs to these population groups, future studies should focus specifically on experiences and perceptions of older CALD people of fall prevention programs as well as the perspectives of program providers. Implications for Rehabilitation Program participation is influenced by cultural values and motivational, social and environmental factors. The meaning and importance of exercise can vary between and within cultures. Exercise and fall prevention interventions need to be culturally appropriate and utilise the positive influences of social support, especially from physicians and family. Providing information that falls can be prevented and the reasons why behaviours need to change will be more likely to encourage older people from CALD backgrounds to contemplate participation.

Understanding the relationships between the physical environment and physical activity in older adults: a systematic review of qualitative studies

BACKGROUND

While physical activity (PA) provides many physical, social, and mental health benefits for older adults, they are the least physically active age group. Ecological models highlight the importance of the physical environment in promoting PA. However, results of previous quantitative research revealed inconsistencies in environmental correlates of older adults' PA that may be explained by methodological issues. Qualitative studies can inform and complement quantitative research on environment-PA relationships by providing insight into how and why the environment influences participants' PA behaviors. The current study aimed to provide a systematic review of qualitative studies exploring the potential impact of the physical environment on older adults' PA behaviors.

METHODS

A systematic search was conducted in databases of various disciplines, including: health, architecture and urban planning, transportation, and interdisciplinary databases. From 3,047 articles identified in the physical activity, initial search, 31 articles published from 1996 to 2012 met all inclusion criteria. An inductive content analysis was performed on the extracted findings to identify emerging environmental elements related to older adults' PA. The identified environmental elements were then grouped by study methodologies [indoor interviews (individual or focus groups) vs spatial methods (photo-voice, observations, walk-along interviews)].

RESULTS

This review provides detailed information about environmental factors that potentially influence older adults' PA behaviors. These factors were categorized into five themes: pedestrian infrastructure, safety, access to amenities, aesthetics, and environmental conditions. Environmental factors especially relevant to older adults (i.e., access to facilities, green open spaces and rest areas) tended to emerge more frequently in studies that combined interviews with spatial qualitative methods.

CONCLUSIONS

Findings showed that qualitative research can provide in-depth information on environmental elements that influence older adults' PA. Future qualitative studies on the physical environment and older adults' PA would benefit from combining interviews with more spatially-oriented methods. Multidisciplinary mixed-methods studies are recommended to establish quantitative relationships complemented with in-depth qualitative information.

Associations of subjective social status with physical activity and body mass index across four Asian countries

OBJECTIVE

The aims of this study were to (1) assess physical activity and weight status differences and (2) explore the direction and shape of subjective social status (SSS) association with physical activity and weight status within four Asian countries.

METHODS

Cross section data of adult respondents from the nationally representative East Asian Social Survey were used for analyses. Logistic regression stratified by gender was conducted for the first aim, and simple and quadratic logistic regression models were used for the second.

RESULTS

SSS was significantly associated with odds of weekly or daily physical activity across all countries and genders, except for South Korean and Japanese females. Quadratic models provided significantly better fit for Chinese males (LR (d.f. = 1) = 6.51, P value <.05) and females (LR (d.f. = 1) = 7.36, P value <.01), South Korean males (LR (d.f. = 1) = 4.40, P value <.05), and Taiwanese females (LR (d.f. = 1) = 4.87, P value <.05).

CONCLUSIONS

This study provides a comparable cross Asian country measure of moderate-to-vigorous physical activity and new findings that a connection exists between SSS and physical activity. Differences of class distinction help explain the different shaped SSS relationships.

The effects of participation in leisure activities on neuropsychiatric symptoms of persons with cognitive impairment: a cross-sectional study

BACKGROUND

People with cognitive impairment have been shown to engage in few structured activities. During periods of unoccupied time or boredom, these patients most likely manifest neuropsychiatric symptoms.

OBJECTIVE

The purposes of this study were to (1) describe the leisure-activity indicators (variety in leisure activities, appraisal of each activity's restorative function, and leisure dysfunction, i.e. failure to appreciate the importance of restorative aspects of leisure activity), of community-dwelling older Taiwanese adults with cognitive impairment, and (2) explore the relationships between these indicators and neuropsychiatric symptoms in this population.

DESIGN

Cross-sectional.

SETTING

Memory disorder and geriatric psychiatric clinics of two hospitals in northern Taiwan.

PARTICIPANTS

Patient-family caregiver dyads (N=60).

METHOD

Patients' dementia severity, based on Clinical Dementia Rating scores, was 0.5-2.0. Family caregivers completed the Chinese Neuropsychiatric Inventory to assess patients' behavioral problems and the Restorative Activity Questionnaire to assess patients' participation in leisure activities, restorative experience, and leisure dysfunction.

RESULTS

On average, patients participated in approximately five individual leisure activities, but very few group leisure activities. The top three leisure activities were watching TV, taking a walk, and talking to relatives and friends. The leisure activities in which participants least commonly engaged were fishing, attending cultural exhibitions, and chess/card playing. All leisure-activity indicators were significantly correlated with disease stage, global cognitive function, and neuropsychiatric symptoms. Two leisure-activity indicators (leisure dysfunction and restorative experiences) were significantly correlated with depressive symptoms. Only leisure dysfunction significantly and consistently predicted neuropsychiatric symptoms.

CONCLUSION

These results can be used by home health or community health nurses to design tailored leisure-activity plans for improving the care quality of patients with cognitive impairment. Health professionals can develop leisure-education programmes to emphasize the value of leisure pursuit and to modify attitudes toward participating in leisure activities. Finally, parks and recreational agencies may re-examine their services and facilities to meet the increasing needs of this population.

Asian American midlife women's attitudes toward physical activity

OBJECTIVES

To explore Asian American midlife women's attitudes toward physical activity using a feminist perspective.

DESIGN

A qualitative online forum study.

SETTINGS

Internet communities/groups for midlife women and ethnic minorities.

PARTICIPANTS

A total of 17 Asian American women recruited through the Internet using a convenience sampling method.

METHODS

A 6-month qualitative online forum was conducted using 17 online forum topics. The data were analyzed using thematic analysis.

RESULTS

Three major themes related to Asian American midlife women's attitudes toward physical activity were extracted from the data: keeping traditions, not a priority, and not for Asian girls. Because Asian American midlife women were busy in keeping their cultural traditions, they rarely found time for physical activity. The women gave the highest priority to their children, and physical activity was the lowest priority in their busy lives. Also, the women were rarely encouraged to participate in physical activity during their childhoods, and they perceived that their weak and small bodies were not appropriate for physical activity.

CONCLUSIONS

Several implications for future development of physical activity promotion programs for this specific population have been suggested based on the findings.

Filipino older adults' beliefs about exercise activity

PURPOSE

This study explored how the older traditional Filipino adults 65 years old and above living in Honolulu, Hawaii, describe their beliefs regarding exercise activity. The location of this research setting is unique because a blending of traditional Filipino culture exists within an acculturated social setting. The Filipino older adults who have relocated to this U.S. location may have also stayed close to their own cultural traditions.

METHODOLOGIES

A perception of exercise activity was generated through the lens of 47 participants using qualitative methodology.

FINDINGS

While focusing on the older adults' beliefs about exercise activity, it became evident that exercise may have been seen as a proxy measure of physical activity. The study revealed four main domains: balancing barriers against benefits; engaging capabilities; intervening factors; and defining exercise. The data suggest that the four themes are juxtaposed among each other, with overarching social obligations to the kin group governing the older adults' engagement in what constitutes structured exercise by Western definition.

IMPLICATIONS

Further investigation is needed to conceptualize what types of physical activities traditional Filipino elders perceive as exercise, and whether these activities fall into the Western definition of exercise.

Leisure-time physical activities for community older people with chronic diseases

AIMS

(1) To explore the types and three components (frequency, duration and caloric expenditure) of leisure-time physical activity in community older people with chronic diseases. (2) To identify leisure-time physical activity-related factors in these community older people.

BACKGROUND

Previous research has focused primarily on measuring the actual physiological or psychological benefits of exercise or leisure-time physical activity, little is known about the factors that determine the frequency, intensity and duration of exercise or leisure-time physical activity. The identification of reliable predictors of the various components of leisure-time physical activity will enable healthcare providers to intervene and change the patterns of leisure-time physical activity in the sedentary older people more effectively.

DESIGN

A cross-sectional design was used for this study.

METHODS

Participants were recruited from the Xinyi District in Taipei, Taiwan. A total of 206 older people were recruited and were asked to complete three questionnaires during a face-to-face interview with a researcher at the activity setting.

RESULTS

The results showed that walking leisurely was the most frequent leisure-time physical activity for participants. The age, gender, living arrangement, affective feeling and environmental control were significant variables of leisure-time physical activity.

CONCLUSIONS

The study constructs accounted for moderate amounts of variance (22% for leisure-time physical activity frequency, 27% for leisure-time physical activity duration and 24% for leisure-time physical activity caloric expenditure). This study also showed that different variables play different influential roles in the different components of LTPA.

RELEVANCE TO CLINICAL PRACTICE

An effective intervention strategy for improving leisure-time physical activity of older people may involve tailoring the type, format, intensity, frequency and duration of a physical activity according to an individual's needs. This study described some environmental barriers to LTPA and recommended an increase in the accessibility to LTPA areas.

Attitudes and Beliefs Predicting Taiwanese Older Adults’ Intentions to Attend Strength and Balance Training Programs

While strength and balance training (SBT) programs are effective in preventing falls, older adults rarely participate. A cross-sectional study design was used to explore factors that influence their decisions to attend SBT programs. Questionnaires were collected that measured theory of planned behavior constructs from 221 community-dwelling Taiwanese older women between the age of 55 and 94. Results suggest that (a) benefits of SBT programs such as increasing independence in daily life, (b) participation approval and involvement from the older adults’ family members, and (c) SBT programs conducted in familiar places strengthened potential participants’ positive attitude, subjective norm, and perceived behavioral control, respectively. Health care professionals should consider incorporating these factors in the recruitment materials or the actual design of SBT programs to enhance older adults’ decision to attend and increase the recruitment rate of such programs.

Cultural beliefs and attitudes toward health and health care among Asian-born women in the United States

OBJECTIVE

To describe Asian-born women's cultural beliefs and attitudes towards health, illness, and health care practices.

DATA SOURCES

Online databases PubMed and CINAHL.

STUDY SELECTION

Twenty-four studies published between January 2000 and May 2009 were retrieved based on the inclusion criteria.

DATA EXTRACTION

Data on publication year, authors, study sample, sample size (only Asian women in the United States were included), design, and related key findings were extracted.

DATA SYNTHESES

Data were organized under three categories: Asian cultural beliefs about health and illness, health promotion and illness prevention, and health care practices. Common beliefs across groups and unique beliefs within specific Asian ethnic groups were synthesized. The results indicated that different Asian ethnic groups share some health beliefs, but each group also has unique health beliefs. Existing literature on cultural health beliefs of Asian-born women is limited.

CONCLUSION

Health care providers can use the findings of this review to improve health care utilization among Asian-born women.

Physical activity status and gender differences in community-dwelling older adults with chronic diseases

BACKGROUND

Physical activity trends have a negative correlation between age and level of activity. Older adults with chronic diseases because of a preponderance of health problems often have difficulty achieving recommended physical activity levels. Lower levels of physical activity among older women have also been reported. Therefore, knowledge that could help tailor interventions to motivate groups at risk (such as older women with chronic diseases) is an important area of study.

PURPOSE

This study was designed to explore physical activity levels and gender-based differences in older adults with chronic diseases in a district in Taipei.

METHODS

This study used a cross-sectional survey design. A total of 206 community-dwelling elders were recruited and asked to complete two questionnaires during face-to-face interviews. The first questionnaire gathered data on sociodemographics and health status, and the second, a modified Community Healthy Activities Model Program for Seniors, was a physical activities questionnaire and gathered data on participants' physical activity habits.

RESULTS

Results found that 54.4% of participants achieved the recommended energy expenditure level of 1000 kcal/week during leisure-time physical activity. Female participants were found less likely to meet the recommended leisure-time physical activity guidelines than their male counterparts. Age significantly predicted caloric expenditure during leisure-time physical activity for female participants, and self-reported health status significantly predicted caloric expenditure during leisure-time physical activity for male participants.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Results demonstrated different physical activity levels in older men and women, with predictive factors of caloric expenditure during leisure-time physical activity also different between genders. Therefore, interventions promoting physical activity should take these differences into account.

Chronic illness self-care and the family lives of older adults: a synthetic review across four ethnic groups

The purpose of this paper is to integrate the literature on family and social ties among older ethnic minority men and women with the literature on chronic illness self-care among elders in these groups, in order to increase understanding of social influences on self-care behavior, raise questions for future research, and inform culturally appropriate interventions to maximize the health-promoting potential of social relationships. The paper presents demographic and chronic illness prevalence information, and then summarizes literature about patterns of chronic illness self-care behaviors for older African-Americans, Latinos, Asian-Americans, and American Indians in the U.S. For each group, the sociological literature about residential, cultural, and socioeconomic patterns, family lives, and other social ties is then reviewed, and the self-care literature that has accounted for these patterns is discussed. Finally, six themes are outlined and related questions are identified to further illuminate the social context of older adults' chronic illness self-care.