Why might adults belong to outdoor walking groups? A qualitative study using photo-elicitation methods in a population with poor health and physical activity indicators

Walking groups have multiple health benefits but walking interventions tend to be socially patterned and have the potential to increase health inequity. This poster presented preliminary findings of a qualitative study with a new walking groups in an area of social deprivatio

Non-urgent accident and emergency department use as a socially shared custom: a qualitative study

This is the final published version. It first appeared at http://emj.bmj.com/content/early/2015/04/03/emermed-2014-204039.abstract.Objective We explored attitudes of non-urgent accident and emergency department (AED) patients in the middle-income healthcare setting Saint Vincent and the Grenadines (SVG) in the Caribbean to understand how and why they decide to seek emergency care and resist using primary care facilities. Methods In 2013, we conducted 12 semistructured interviews with a purposive sample of non-urgent AED users from a variety of social backgrounds. Verbatim transcripts were analysed with a grounded theory approach. Results In this study, we found, first, that participants automatically chose to visit the AED and described this as a locally shared custom. Second, the healthcare system in SVG reinforced this habitual use of the AED, for example, by health professionals routinely referring non-urgent cases to the AED. Third, there was also some deliberate use; patients took convenience and the systemic encouragement into account to determine that the AED was the most appropriate choice for healthcare. Conclusions We conclude that the attitudes and habits of the Vincentian non-urgent patient are major determinants of their AED use and are intricately linked to local, socially shared practices of AED use. Findings show that health services research should reconsider rational choice behaviour models and further explore customs of health-seeking.CG was supported by the Medical Research Council

Tactics of diabetes control: Turkish immigrant experiences with chronic illness in Berlin, Germany.

This thesis explores Turkish migrants’ practices of diabetes care in Germany. Health statistics frequently identify minority groups as vulnerable to chronic illness and Turkish-origin Germans are said to be more likely to suffer from type 2 diabetes than Germans or Turks in Turkey. Anthropological studies on marginal population groups with diabetes explore experiences of social suffering and inequality that influence such high illness prevalence, or investigate how conflictual lay beliefs and medical encounters affect illness care. Those studies that analyse active diabetes patient and healthcare practices concentrate on the majority population. Drawing on ethnographic fieldwork in Berlin from September 2006 to September 2007, this thesis examines how Turkish Berliners actively engage in diabetes care, and thus joins two themes seldom connected: illness practices and marginality. Initial interviews with healthcare professionals alluded to a Turkish migrant patient group living in deprivation and immobilised by high illiteracy rates, lacking language skills and health knowledge. Despite such experience of marginality, ethnographic exploration revealed that informal diabetes care, for example through a Turkishlanguage self-help group, is nonetheless individually and collectively negotiated where formal care is inadequate. On the one hand, the thesis investigates practices of diabetes control in learning, monitoring and manoeuvring diabetes. Rather than representing the common image of the inert, disadvantaged migrant patient, Turkish Berliners of the self-help group engage in deliberate “tactics of diabetes control” to make their chronic illness experience habitable. On the other hand, the thesis explores how “diabetes among Turkish-origin Berliners” can be a form of sociality, political activism and economic enterprise that involves many social actors not only patients and their healthcare professionals, in order to fill a provision gap

The experience of physical activity and the transition to retirement: a systematic review and integrative synthesis of qualitative and quantitative evidence.

BACKGROUND: The transition to retirement has been recognised as a critical turning point for physical activity (PA). In an earlier systematic review of quantitative studies, retirement was found to be associated with an increase in recreational PA but with a decrease in PA among retirees from lower occupational groups. To gain a deeper understanding of the quantitative review findings, qualitative evidence on experiences of and views on PA around the transition to retirement was systematically reviewed and integrated with the quantitative review findings. METHOD: 19 electronic databases were searched and reference lists were checked, citations tracked and journals hand-searched to identify qualitative studies on PA around the transition to retirement, published between January 1980 and August 2010 in any country or language. Independent quality appraisal, data extraction and evidence synthesis were carried out by two reviewers using a stepwise thematic approach. The qualitative findings were integrated with those of the existing quantitative systematic review using a parallel synthesis approach. RESULTS: Five qualitative studies met the inclusion criteria. Three overarching themes emerged from the synthesis of these studies: these related to retirees' broad concepts of PA, the motives for and the challenges to PA in retirement. Integrative synthesis of the qualitative findings with the quantitative evidence offered several potential explanations for why adults might engage in more recreational PA after the transition to retirement. These included expected health benefits, lifelong PA patterns, opportunities for socialising and personal challenges, and the desire for a new routine. A decrease in PA among retirees from lower occupational groups might be explained by a lack of time and a perceived low personal value of recreational PA. CONCLUSIONS: To encourage adoption and maintenance of PA after retirement, interventions should promote health-related and broader benefits of PA. Interventions for retirees from lower occupational groups should take account of busy post-retirement lifestyles and the low personal value that might be attributed to recreational PA. Future research should address predictors of maintenance of recreational PA after the transition to retirement, the broader benefits of PA, and barriers to PA among retirees from lower occupational groups.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Walking and cycling to work despite reporting an unsupportive environment: insights from a mixed-method exploration of counterintuitive findings.

BACKGROUND: Perceptions of the environment appear to be associated with walking and cycling. We investigated the reasons for walking and cycling to or from work despite reporting an unsupportive route environment in a sample of commuters. METHODS: This mixed-method analysis used data collected as part of the Commuting and Health in Cambridge study. 1164 participants completed questionnaires which assessed the travel modes used and time spent on the commute and the perceived environmental conditions on the route to work. A subset of 50 also completed qualitative interviews in which they discussed their experiences of commuting. Participants were included in this analysis if they reported unsupportive conditions for walking or cycling on their route (e.g. heavy traffic) in questionnaires, walked or cycled all or part of the journey to work, and completed qualitative interviews. Using content analysis of these interviews, we investigated their reasons for walking or cycling. RESULTS: 340 participants reported walking or cycling on the journey to work despite unsupportive conditions, of whom 15 also completed qualitative interviews. From these, three potential explanations emerged. First, some commuters found strategies for coping with unsupportive conditions. Participants described knowledge of the locality and opportunities for alternative routes more conducive to active commuting, as well as their cycling experience and acquired confidence to cycle in heavy traffic. Second, some commuters had other reasons for being reliant on or preferring active commuting despite adverse environments, such as childcare arrangements, enjoyment, having more control over their journey time, employers' restrictions on car parking, or the cost of petrol or parking. Finally, some survey respondents appeared to have reported not their own environmental perceptions but those of others such as family members or 'the public', partly to make a political statement regarding the adversity of active commuting in their setting. CONCLUSIONS: Participants report walking and cycling to work despite adverse environmental conditions. Understanding this resilience might be just as important as investigating 'barriers' to cycling. These findings suggest that developing knowledge of safe walking and cycling routes, improving cycling confidence and restricting workplace parking may help to encourage walking and cycling to and from work.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Negotiating multisectoral evidence: a qualitative study of knowledge exchange at the intersection of transport and public health.

BACKGROUND: For the prevention and control of chronic diseases, two strategies are frequently highlighted: that public health should be evidence based, and that it should develop a multisectoral approach. At the end of a natural experimental study of the health impacts of new transport infrastructure, we took the opportunity of a knowledge exchange forum to explore how stakeholders assessed, negotiated and intended to apply multisectoral evidence in policy and practice at the intersection of transport and health. We aimed to better understand the challenges they faced in knowledge exchange, as well as their everyday experiences with working in multisectoral remits. METHODS: In 2015, we conducted participant observation during an interactive event with 41 stakeholders from national and local government, the third sector and academia in Cambridge, UK. Formal and informal interactions between stakeholders were recorded in observational field notes. We also conducted 18 semistructured interviews reflecting on the event and on knowledge exchange in general. RESULTS: We found that stakeholders negotiated a variety of challenges. First, stakeholders had to negotiate relatively new formal and informal multisectoral remits; and how to reconcile the differing expectations of transport specialists, who tended to emphasise the importance of precedence in guiding action, and health specialists' concern for the rigour and synthesis of research evidence. Second, research in this field involved complex study designs, and often produced evidence with uncertain transferability to other settings. Third, health outcomes of transport schemes had political traction and were used strategically but not easily translated into cost-benefit ratios. Finally, knowledge exchange meant multiple directions of influence. Stakeholders were concerned that researchers did not always have skills to translate their findings into understandable evidence, and some stakeholders would welcome opportunities to influence research agendas. CONCLUSIONS: This case study of stakeholders' experiences indicates that multisectoral research, practice and policymaking requires the ability and capacity to locate, understand and communicate complex evidence from a variety of disciplines, and integrate different types of evidence into clear business cases beyond sectoral boundaries

Negotiating multisectoral evidence: a qualitative study of knowledge exchange in transport and public health

Background Evidence-based public health requires research to support policy. There is a large amount of literature on strategies for knowledge translation or more discursive knowledge exchange. However, little evidence exists for their effectiveness and underlying mechanisms, especially with regard to multisectoral, multidisciplinary evidence in knowledge mobilisation. Taking the opportunity of a knowledge exchange forum at the end of a natural experimental study, we investigated how stakeholders assess, negotiate, and use multisectoral evidence. Methods Participants represented both existing and newly interested stakeholders of the natural experimental study, from national and local government, the third sector, and academia. We conducted participant observation during an interactive event with 41 stakeholders and semi-structured interviews with 17 of them. Formal and informal interactions between stakeholders were recorded in field notes. Interviews considered the event format and content as well as knowledge exchange in general. Thematic content analysis of field notes and transcripts was undertaken. Findings Stakeholders working across sectors expressed uncertainties about finding a common language between research and practice and between sectors, and about who had the capacity to translate across these boundaries. They also expressed differing expectations of evidence. Whereas public health specialists tended to have a hierarchical view of evidence that favoured trials, transport specialists tended to prefer case studies as precedents for workable solutions. However, stakeholders encountered uncertainties about their preferred evidence. Population health studies generated more complex results than did those of apparently clear-cut randomised controlled trials; case studies highlighted the context-dependency of evidence and difficulties in transferring insights across settings. Finally, stakeholders had to reconcile uncertainties about “health in all remits”. Despite its premise, public health was not always acknowledged to contribute to the goals of other policy sectors, and stakeholders had to negotiate competing priorities, such as those between health improvement and economic growth, or between integrated and designated budgets. Interpretation This case study of stakeholders' experiences indicates that multisectoral research, practice, and policymaking require the ability and capacity to locate, understand, and communicate complex evidence from a variety of disciplines, and integrate different types of evidence into clear business cases

How do couples influence each other’s physical activity behaviours in retirement? An exploratory qualitative study

BACKGROUND: Physical activity patterns have been shown to change significantly across the transition to retirement. As most older adults approach retirement as part of a couple, a better understanding of how spousal pairs influence each other’s physical activity behaviour in retirement may help inform more effective interventions to promote physical activity in older age. This qualitative study aimed to explore and describe how couples influence each other’s physical activity behaviour in retirement. METHODS: A qualitative descriptive study that used purposive sampling to recruit seven spousal pairs with at least one partner of each pair recruited from the existing EPIC-Norfolk study cohort in the east of England, aged between 63 and 70 years and recently retired (within 2-6 years). Semi-structured interviews with couples were performed, audio-recorded, transcribed verbatim and analysed using data-driven content analysis. RESULTS: Three themes emerged: spousal attitude towards physical activity, spouses’ physical activity behaviour and spousal support. While spouses’ attitudes towards an active retirement were concordant, attitudes towards regular exercise diverged, were acquired across the life course and were not altered in the transition to retirement. Shared participation in physical activity was rare and regular exercise was largely an individual and independent habit. Spousal support was perceived as important for initiation and maintenance of regular exercise. CONCLUSIONS: Interventions should aim to create supportive spousal environments for physical activity in which spouses encourage each other to pursue their preferred forms of physical activity; should address gender-specific needs and preferences, such as chances for socialising and relaxation for women and opportunities for personal challenges for men; and rather than solely focusing on promoting structured exercise, should also encourage everyday physical activity such as walking for transport

Barriers and facilitators to physical activity amongst overweight and obese women in an Afro-Caribbean population: A qualitative study.

BACKGROUND: The 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. METHODS: Seventeen 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. RESULTS: Social, 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. CONCLUSIONS: It 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.MA was supported by the Institute of International Education through a Fulbright Scholarship. CG was supported by the Medical Research Council.This is the final version. It was first published by BioMed Central at http://www.ijbnpa.org/content/12/1/97

'Keeping your body and mind active': an ethnographic study of aspirations for healthy ageing.

OBJECTIVE: To describe and explore perceptions, practices and motivations for active living in later life. DESIGN: Qualitative study with semistructured interviews and 'semistructured' participant observations of participant-selected activities, such as exercise classes, private or organised walks, shopping and gardening. PARTICIPANTS: 27 participants (65-80 years) from the European Prospective Investigation into Cancer Norfolk study, purposefully selected by gender, age, occupational class, living status and residential location; 19 of the participants agreed to be accompanied for observed activities. SETTING: Participants' homes, neighbourhoods, places of leisure activities and workplaces in Norfolk, England. RESULTS: All participants regarded a positive attitude as important for healthy ageing; this included staying active, both physically and mentally through sedentary activities such as reading and crosswords. 'Getting out of the house', being busy, or following a variety of interests were regarded as both important motivators and descriptions of their 'activeness'. Purposeful activities formed an important part of this, for example, still being engaged in paid or voluntary work, having caring responsibilities, or smaller incidental activities such as helping neighbours or walking for transport. Many also reported adapting previous, often lifelong, activity preferences and habits to their ageing body, or replacing them altogether with lower impact activities such as walking. This included adapting to the physical limitations of partners and friends which dictated the intensity and frequency of shared activities. The social context of activities could thus form a barrier to active living, but could also encourage it through companionship, social responsibilities and social pressures. CONCLUSIONS: Promoting and maintaining physical activity among older people may require more attention to activeness as an attitude and way of life as well as to its social context, and initiatives encouraging broader activity habits rather than discrete activities.This work was supported by the UK Research Councils’ Lifelong Health and Wellbeing (LLHW) Initiative in partnership with the Department of Health [grant number MR/K025147/1]; LLHW is led by the Medical Research Council. The work was undertaken under the auspices of the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence which is funded by the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust. SG and DO are also supported by the Medical Research Council [Unit programme numbers MC_UU_12015/4 and MC_UU_12015/6].This is the final version of the article. It was first available from BMJ via http://dx.doi.org/10.1136/bmjopen-2015-00997