Motives and Barriers to Lifestyle Physical Activity in Midlife South Asian Indian Immigrant Women

Background: Lifestyle physical activity (i.e. planned / unplanned leisure, occupational or household activities) is vital to reduce the risk of chronic illness such as cardiovascular disease, diabetes and metabolic syndrome. Such activity is crucial for South Asian Indian (SAI) women who have more than twice the risk for cardiovascular disease and diabetes than other groups. In spite of national efforts to eliminate healthcare disparities related to poor physical activity, lifestyle physical activity in SAI women is classified as low active levels measured by average daily step counts (6814). In fact, only 52% of SAI women meet recommended physical activity guidelines (≥150 minutes moderate-intensity per week) through leisure-time, household, and occupational activities which may explain the increased prevalence of cardiovascular disease and diabetes in this population. The proportionate mortality ratio for cardiovascular disease for SAI women is higher (1.4) than for SAI men (0.89). Similarly, the age adjusted predicted risk for coronary artery disease for SAI women is higher (0.88%) compared to White women (0.61%). Further, the prevalence rate of diabetes for SAI women is higher (14%) than that of overall Asian Americans (9%). The high prevalence of chronic illness and low physical activity in SAI women underscore the need for identifying culturally sensitive factors that could influence the lifestyle physical activity behavior of this at-risk population of minority immigrants.

Purpose: The purpose of the study was to examine the motives and barriers to lifestyle physical activity behavior in midlife South Asian Indian immigrant women at risk for cardiovascular disease and diabetes.

Methods: A qualitative approach comprising five focus groups of midlife SAI women was used in this study. Forty participants were recruited from SAI places of worship such as Christian churches, Hindu temples, Sikh gurudwaras, and a SAI community organization. Eligible participants included SAI immigrant women who were born in India, immigrated to the United States and spoke English or Hindi as their primary language. They were defined as being 40 to 65 years old and having no disability that interfered with walking. Purposeful and snowball sampling were used as potential participants were encouraged to inform other SAI immigrant women about the study.  The five focus groups consisting of seven to ten participants per group were held in places of worship. Two groups were conducted in English and three in Hindi. Focus groups were divided into two age groups (40-50 age group and 51-65 age group). The focus group questions were open-ended and semi-structured. The questions were translated from English into Hindi using the committee method on translation methodology. The main question about motives to physical activity focused on asking participants’ views on factors that would motivate them to be more physically active in their daily lifestyle. Similarly, the main question about barriers to physical activity focused on asking participants’ views on factors they considered as barriers to be physically active in their daily lifestyle. Participants were encouraged to engage in the focus group discussion and to share their personal perspectives even if they differed from the views of other participants. Transcribed and de-identified audio taped sessions from two focus groups in Hindi and three in English were coded independently by three researchers. The data were then analyzed using Atlas-ti software. During the coding process, participants perspectives related to Motives and Barriers in a healthy lifestyle were categorized into themes and subthemes. Audit trails of the data that included detailed memos and ongoing meetings with researchers to confirm interpretations of the findings reinforced the rigor of the qualitative research process. 

Results: The median age of the 40 participants was 50 years (M= 51, SD=7.0) and the majority immigrated from either the northern (n=16, 40%) or southern (n=16, 40%) regions of India. Time period since immigration to the United States varied from 2 to 30 or more years. Participants were predominantly married (n=38, 95%) with their average household size of 4.3 (SD= 1.25) adult and child members. Findings revealed that self-motivation was a core theme for motives promoting physical activity with three subthemes consisting of optimal physical and psychological health, emphasis on external beauty, and strong social support network. Role expectation was a core theme related to barriers to physical activity with four subthemes consisting of lack of time, lack of internal locus of control, diminished social support network, and environmental constraints. 

Conclusion: Lifestyle physical activity is crucial to promote health and wellbeing among SAI women since it may reduce the risk for chronic illness such as cardiovascular disease and diabetes in this population. Understanding the motives and barriers that SAI women face related to lifestyle physical activity is a first step in devising interventions that can lead to healthier outcomes.