Elsevier

Public Health

Volume 120, Issue 4, April 2006, Pages 309-319
Public Health

Original Research
Factors associated with non-participation in a physical activity promotion trial

https://doi.org/10.1016/j.puhe.2005.11.003Get rights and content

Summary

Background

Non-participation can bias outcome in intervention studies of physical activity.

Objectives

To compare characteristics, knowledge and attitudes to physical activity in participants and non-participants of a physical activity intervention trial in primary care.

Study design

Cross-sectional survey.

Methods

Patients aged 40–64 years were recruited opportunistically during surgery visits in an inner city general practice in Newcastle upon Tyne, UK. Attitudes to physical activity, views of its health benefits, and barriers to participation were elicited in interviews with participants, and by postal questionnaire from non-participants. Data held by general practitioners were used to compare anthropometry and lifestyle between groups.

Results

Of 842 eligible patients, 276 (33%) refused outright (non-volunteers) and 566 volunteered for the intervention study, of which 353 (42%) attended a baseline assessment and 213 (25%) subsequently defaulted. The initial refusal rate was higher amongst men, smokers and those with addresses in more deprived areas. The response rate to the postal survey of non-volunteers was 45%. Compared with participants, the non-volunteers were more likely to be an adult carer and to report poorer health, and were less likely to have had higher education or to have children living at home. Far more non-volunteers considered that they already did enough exercise to maintain health. Non-volunteers had slightly less knowledge of the benefits of physical activity; attached far less importance to it in maintaining health; were more likely to cite ‘fear of leaving their home unattended’, ‘do not enjoy exercise’ and ‘poor health’ as barriers to exercise; and were less likely to cite ‘no one to exercise with’ as a barrier to exercise.

Conclusion

Recruitment of ‘hard to engage’ individuals requires careful phrasing of the message to focus on their personal goals and to address gaps in their knowledge about physical activity and the principal barriers they perceive. Differential uptake across population subgroups could lead to a widening of health inequalities.

Introduction

There is compelling scientific evidence that an active lifestyle maintains health and prolongs life.1 The association is considered to be causal2, 3 and shows a dose-response relationship, with the intensity, duration and frequency of physical activity (PA) determining the nature and level of health benefits.4 Significant improvements to public health may be achieved by adopting a moderate level of PA, and this is reflected in recent guidance from the UK Government.5 Primary care is an important sector for encouraging people to adopt a more active lifestyle,5, 6 but the cost-effectiveness of interventions to increase PA is critically dependent on uptake.7 Characteristics of non-attenders for health checks in primary care have been described8, 9 whereby, for example, men and smokers are the ‘hard to engage’ groups. Similar findings have been noted in interventions promoting PA.10, 11 However, to inform the evidence base, there is a need for information on the knowledge, views and attitudes of those in disadvantaged groups resistant to health messages to improve recruitment.5 For example, it is already established that attitudes to healthy lifestyles, including habitual exercise, differ between social classes.12 Such information could be used when planning recruitment strategies and when assessing the degree of study response bias. Health professionals also need a detailed understanding of the motivating factors that encourage people to exercise and the principal barriers that inhibit them,13 because overcoming barriers is an important component of the behaviour change process.14 Barriers may be described as internal, such as lack of motivation, or external, such as lack of transport.15 The distinction is important as external barriers are more amenable to change. People who only cite internal barriers are less likely to change their exercise behaviour than those who cite external barriers.15 To help interpret and plan other studies, the authors investigated the characteristics and attitudes of people who declined to join the Newcastle Exercise Project (NEP), a randomized controlled trial of interventions to promote PA in Newcastle upon Tyne.16

Section snippets

Methods

Details of the methods used in the NEP have been published previously.16 Over 12 months, patients aged 40–64 years were recruited opportunistically by one of the authors (JH) working in one general practice (list size 11,400) situated in a socio-economically disadvantaged inner city area of Newcastle upon Tyne. The practice population was predominantly white (>99%). The researcher approached the patients whilst attending their primary care physician (general practitioner, GP). The study was

Analysis

General practice computerized patient data were used to compare age, sex, anthropometry, smoking habit and TDS between participants, defaulters and non-volunteers. Separate analyses were undertaken comparing the participants and the combined group of defaulters and non-volunteers (non-participants). The questionnaire replies were used to compare social characteristics, general health, self-perceived activity and fitness level, attitudes to PA, knowledge of the benefits of PA and the reported

Results

Over the 12-month study, 1296 individuals were approached opportunistically (44.4% of registered patients aged 40–64 years); 26 were excluded because they were already sufficiently active and 428 were excluded on medical grounds, with the principal reasons being inability to pedal a cycle due to orthopaedic or rheumatic disease (n=128), patient on treatment with beta-blockers (n=96) or patient had asthma or chronic obstructive pulmonary disease (n=46). Hence, 842 patients were judged to be

Main findings

Analysis of GP-held data showed that those who did not participate in a trial promoting PA in middle-aged patients attending their primary care physician were more likely to be smokers and to live in more disadvantaged areas. These findings are in keeping with the general experience of others regarding the uptake of health checks in UK general practice9, 23, 24, 25 and recruitment into exercise programmes.10, 11

Analysis of questionnaire replies suggested that non-volunteers were less likely to

Acknowledgements

The authors acknowledge the contribution made by staff at the Walker Medical Centre, Mrs Lorna Farr and the patients who participated. Dr Simon Raybould (University of Newcastle) provided data for the Townsend deprivation scores. The work formed the basis of a thesis submitted by DJC in part fulfilment of the requirements of an MSc in Health Sciences, University of Newcastle upon Tyne. DJC and JH were supported by a grant from the NHS R&D Cardiovascular Disease and Stroke Programme.

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