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Exploring the meaning of, the barriers to and potential strategies for promoting physical activity among urban Indigenous Australians
Julian Hunt, Alison L. Marshall, David Jenkins
Available data clearly and consistently show Indigenous Australians have significantly lower life expectancies than other Australian men and women. This is despite the fact that the life expectancies of Indigenous men and women increased to 59 years for Indigenous males and 65 years for Indigenous females between 1996 and 2001. Unfortunately, however, these data are similar respectively to the life expectancy of the non-Indigenous Australian men in 1901-1910 and the women in 1920-1922.1 In 2002, Indigenous Australians were twice as likely to report their health was fair to poor when compared to non-Indigenous Australians. Overall Indigenous Australians experience greater mortality and morbidity from non-communicable diseases. The main cause of death among Indigenous Australians is disease of the circulatory system (heart attacks, heart failure
and stroke).2 The age-standardised prevalence of diabetes/high sugar levels among Indigenous people was 3.4 times the rate in non-Indigenous people (ABS 2006). Indigenous Australians were almost twice as likely to be obese (27%) compared with 15% of non-Indigenous Australians.3 Many of these chronic lifestyle-related problems have been attributed to changes in lifestyle since European settlement, specifically poor diet and physical inactivity.4,5 In 2002, just over half (51%) of Indigenous Australians aged ≥15 years had not played sport or participated in any physical activity in the last 12 months, with inactivity rates increasing with age.3 Physical activity has been touted as the ‘best buy’ for public health.6 Yet, few data exist that describe the physical activity of Australia’s Indigenous population. Data collected by the Australian Institute of Health and Welfare (AIHW), suggest that Australia’s Indigenous adults were less likely to be physically
Issue addressed: There is evidence that many of the chronic lifestyle-related problems faced by Australia’s Indigenous population are related to physical inactivity. However, little is known as to how to introduce physical activity programs that will be meaningful, relevant and acceptable to Australia’s Indigenous people. Methods: Seventeen focus groups involving 96 Indigenous adult participants, explored the meaning of, the barriers to, and potential strategies for promoting physical activity among urban Indigenous Australians. Indigenous researchers moderated the groups and data were transcribed verbatim and analysed independently. Results: The relationship between physical activity and health was well understood by participants. Commonly reported activities undertaken by participants included walking, domestic chores and specific sports. Barriers to activity included being judged by others when in public spaces, cost and accessibility. Family engagement and group-based activities were strong motivators for participation. Conclusions: Attempts to increase physical activity among urban Indigenous Australians must engage the community from the outset, and focus on increased opportunities for family-orientated activities, and/or group walking programs; cost and safety must also be addressed. Key words: physical activity, Aboriginal, Torres Strait Islander, walking
Health Promotion Journal of Australia 2008; 19:102-8
The findings of this study may be used as a guide towards developing effective physical activity programs for urban Indigenous Australians. Local communities must be involved in developing new family-orientated initiatives so that programs will be meaningful, relevant and acceptable to Australia’s Indigenous people.
Health Promotion Journal of Australia 2008: 19 (2)
Indigenous people rarely participated in activities that only involved themselves. each organisation received a briefing session on the current evidence pertaining to the state of Indigenous health and the importance of the research project. The focus groups were facilitated by an Indigenous Health Promotion Officer and an Indigenous research student.10 They found that participants conceptualised physical activity in three ways: 1) exercise. The Health Promotion Journal of Australia 2008: 19 (2) 103 . AIHW also reported that 40% of the Indigenous participants reported no leisure-time physical activity compared with 34% of non-Indigenous Australians. as an optional activity.8 In a recent review of physical activity interventions for Australia’s Indigenous population. is positively supported within the context of the family and community. the barriers to. a necessary part of life. and the types of physical activities they participated in.10 That is. it is important to note that Indigenous Australian groups are not homogenous. Participants were informed that the focus group discussions would be tape-recorded to preserve the accuracy of what was discussed. especially when the main aim was to maintain their own health.10 A significant challenge for promoting physical activity to Indigenous Australians is knowing how to develop and implement effective. participants did report that they would engage in individualised activity in response to managing acute illness. physical activity participation among urban Indigenous communities. That is. They then introduced themselves. and the discussion began. The aim of this research was to extend the work of Thompson and colleagues10 to generate a deeper understanding of issues related to physical activity among urban Indigenous Australians living in Brisbane. and that Indigenous women (42%) were more likely to be inactive than Indigenous men (38%). This helped to gain peoples’ interest and trust. However. participants were recruited from organisations and groups that delivered various Indigenous community programs. This research was approved by The University of Queensland Human Research Ethics Committee (approval number: 2022000867) and by local Indigenous community organisations.11 thus further research is required to identify culturally appropriate ideals that may be drawn upon when developing community specific physical activity programs. the first between November 2002 and July 2003. and a need to fast track research in this area into the scientific literature. They also reported that physical activity. This helped to identify which of the groups included people that met the inclusion criteria for the study. to specifically explore the meaning of. Eligible participants included those who identified as being an Aboriginal and/or Torres Strait Islander. appropriate and sustainable initiatives.9 Interestingly. The group discussions focused on the participants’ understanding and perception of physical activity. Methods Qualitative data were collected from members of an urban Indigenous community through a series of focus groups. Shilton and Brown noted a lack of evidence on which to develop effective physical activity interventions. while the second between June 2004 and December 2004.Exploring Health Behaviours Promoting physical activity among urban Indigenous Australians active in their leisure time than non-Indigenous Australians. and their families’ origin to the group. Permission to recruit participants and conduct the groups was sought from the organisations’ leaders. thus improving the capacity for developing programs that may increase participation among urban Indigenous Australians. Prior to data collection. It also helped people to gain a sense that they would be contributing to the evidence to assist in developing programs and resources to specifically meet the needs of urban Indigenous people. and potential strategies to promote physical activity participation among urban Indigenous Australians. Focus group procedures Each focus group began with participant’s completing a brief demographic questionnaire. Two series of focus groups were conducted. arrangements were made to talk to the groups that regularly visited the organisations. but negatively associated with the promotion of individual physical health. Participants’ were then given information sheets and informed consent forms which explained their rights and responsibilities regarding the research. The findings of this research could then be used to initiate further investigation of factors important to Indigenous people’s physical activity. Those interested in participating in the focus groups completed and signed the informed consent forms.10 Thompson and colleagues interviewed 57 urban Indigenous Australians aged between 20 and 50 years living in Melbourne. Once permission was granted. like food. the literature review conducted to inform this study identified just one study that attempted to understand the social and cultural context of physical activity among urban Indigenous people. the barriers limiting their participation and development of potential strategies that could promote. Participant Recruitment Due to the difficulty in identifying and randomly selecting Aboriginal and Torres Strait Islander people from the population. Further. 2) everyday activities. and 3) sport for improving one’s individual performance.7 Bauman and colleagues (2002) noted that before physical activity can be addressed in this population group a better understanding the physical activity needs of these people must be established. were aged over 18 years and who lived in the urban community.
2) the barriers limiting their participation. While sport dominated the discussion among the male participants. while the females focused on non-contact sports such as netball and basketball. “I walk to the train station once a week” or “getting the kids off to school and then going to pick them up you know… until they are big enough to walk home themselves. they tended to be chores outside the house that were more vigorous. Marshall and Jenkins Article formal discussion then began with a broad question about what physical activity meant to them followed by what types of physical activity they did. Feedback session A feedback session was held at an Indigenous community centre and lunch was provided. Finally. as two women said. Most participants identified as being Aboriginal (n=56). Many were in full-time employment (n=41).12 Each analyst classified the data according to the three main research questions: 1) participants understanding and perception of physical activity. and “all our activities are done in the house”. what was the best time for them to do physical activity. When the discussion group finished. eight were employed part-time. “mucking around with the kids in the water”. 104 Health Promotion Journal of Australia 2008: 19 (2) . and 3) potential strategies to promote physical activity participation among urban Indigenous Australians. three participants had completed year 12. For example. The majority of participants (n=36) were either married or in a defacto relationship and the remainder were single (n=20). During the second round of data collection. walking up and down that hill”. 11 focus groups were conducted with 62 Indigenous people (n=25 males and 37 females). Quotes that represent the essence of each theme are presented in the results. Contact sports such as football and boxing dominated the males’ discussion. Nine participants reported they were aged 18-30 years. While some males identified domestic chores as physical activity. then across the complete dataset. many participants reported walking as part of their daily schedule. A high proportion of the sample had attended university or a college of advanced education (n=44). The Indigenous researcher gave an overview of the study and explained how the findings could be used to advocate for the development of Indigenous physical activity programs. The majority of participants (n=39) were aged 30-44 years. two were retired and two did not respond. Walking also emerged as a common activity for both genders. hanging out clothes. female participants felt that physical activity “doesn’t have to be sport or anything – it’s physical”. they were asked what would make it easier for them to do more activity. The male participants clearly felt physical activity was “exercise”. nine were unemployed. “fitness”. and what types of physical activity they did responses tended to be gender-specific. The women in the groups viewed physical activity as walking and household chores. what made it difficult for them to be physically active. “chop down tress and chainsaw”. Most participants reported they had been to high school. Each group involved between five and 10 people. “my exercise is doing my laundry. six had a trade/certificate and four had been to university. “any type of physical activity that sort of gets the heart rate up”. and the types of physical activities they participate in. six were both Aboriginal and/or Torres Strait Islander. Only four were aged 45-54 years and 19 were 55 years and over. Results Focus group participants Six focus groups involving between four and eight participants were conducted during the first round of data collection (total N=34 participants: n=20 males and 14 females). and what activities they would like to do more of. Perceptions of and types of physical activity they participate in When participants were asked what physical activity meant to them. widowed (n=2) or did not respond (n=4).Hunt. 16 were aged 31-50 years and eight over 50 years. Participants were again thanked for their time and willingness to assist in the research. Data analysis Descriptive statistics were calculated from the demographic questionnaire data using SPSS v11. The thematic analysis followed a systematic and iterative process. especially among the female participants who consistently reported engaging in activities that involved their children. For example. the ‘cut and paste technique’. the participants were thanked for their time and reminded that they would be invited to the feedback session upon completion of the study. running after the kids”. like “raking up the leaves and mowing”. “weights” and/or “sport”. Each focus group discussion was transcribed verbatim and transcripts thematically analysed independently by two researchers. while the males reported that it was “sport. whereby major themes and categories were identified and used to classify data from each group.” There was also a large emphasis on the family-orientated activities. “running with the kids. All identified as Indigenous. Both genders reported playing touch football. For example. in particular walking for transport. The separate analyses were compared and discrepancies discussed with a third researcher until consensus was reached. doing some sort of sporting activity”. some of the female participants also reported participating in sport.
and the environment they live in.” Many of the female participants highlighted the demands of bringing up small children and explained how this affected their own activity levels: “We are strained by trying to bring Identifying strategies to make being physically active easier When asked what activities they would like to do more of and what would make it easier for them to do more activity a variety of responses were generated. Most participants had children. You know times have changed and we got cars now. many commented that these opportunities did not last and that there was an absence of sustainable family-orientated activities. We got some strong families around that get together and go and play in the park with the kids and get up and play sports. have a group of people they are the ones to motivate you” or “get a group together to do line dancing sort of stuff”.” Another common perspective was that it was important for adults to be active role models for young people. illness or disability. One participant’s quote represents how many felt. We used to walk from West End down to the Valley. As one female participant said. thus many suggestions related to the need to provide opportunities for families to be active together. you know. For example. “It just costs too much”. For example – swimming – “Not many here in Logan go for a swim you know” – gardening – “I don’t think you find that many young Murris doing gardening or that” or cycling – “because not very many Murri adults got a bike and be riding one”. the cost was again identified as a barrier. “… you know. “I can’t jog for long distances because of injuries I got playing competitive rugby league” and “because of my injury I’m not very active now. “we want our own stuff instead of going to Brisbane”. you know. but here. We are stressed when we are trying to find some sort of activity for our kids and at the same time we are not looking after number one you know?” Other reasons for not participating in more physical activity included perceived affordability. Another barrier to regular physical activity was the perceived lack sustainable local physical activity programs. you can’t afford to go out and do anything for yourself”. I use what I have there because I can’t afford to go outside. However. up some of our kids. a number of participants reported that their physical activity patterns had changed as a result of changes to their circumstances (such as having children). Local accessibility of opportunities was also identified as an issue to ongoing participation. one male participant said. reflecting the importance of family in Indigenous communities.” Barriers and challenges to physical activity When asked what made it difficult for them to be physically active. I don’t bother walking on the streets. people can’t afford to get the family involved”.” and “When you’re paying for your kids. like carnivals or tournaments: “we want to have a little girls netball team… a mothers team… things like that… ongoing. “they are trying to promote sports but the cost factor involved. “I am not really into physical activity except around the house. Some participants reported that many sports were only short-lived. I used to play netball and we played because it was fun”. they said. not a one off. “make it fun. For example. For example. It is the environment we live in and these kids understand that. “There are a lot of people out there who do exercise on weekends. we wouldn’t jump on the bus we would walk. “We walk down the street and people are watching us and we don’t like that. Many participants felt that a key factor for ongoing participation was that the activity should be fun and not feel like a chore. security and personal safety were also a concern in public spaces. offered as a one-off activity. Back home we felt safe and we could walk around and no one would worry about us.” For the female participants. we are all human beings. you come here and it is all stopped and we don’t do those things now you know”. However. That is why I don’t like street walking because people all of a sudden they are judging me and watching me and thinking: is he going to steal my car or something? That is the perception you get all the time you are walking around. For example. “It is different like when I was living over at Straddie you know we would walk to the beach. or to do it as a family”. whether it be “walking groups. “Hey security reasons and you know they are frightened you know the local group that comes down here… things like that will stop families and whatever going to where you know and just other people. you know just accessing the parks.” Many groups made comments about the social environment in which they lived and a feeling of ‘being judged’ in public spaces as a barrier to getting out and about more. Health Promotion Journal of Australia 2008: 19 (2) 105 . For example. For example.” For the males one of the main factors stopping them from ongoing participation in sports was injury. but group based activities were a popular suggestion. Along similar lines another female participant spoke of moving to an urban setting: “you know before living in the city we never had a car… we used to walk from one end of the city to the other you know. go fishing and things like that and would walk way out. Participants again mentioned that there were occasional sports events and teams that they and their family could join.Exploring Health Behaviours Promoting physical activity among urban Indigenous Australians Among the activities mentioned there were also some that the participants reported that they would not do. to train the children to teach them how to get active and that. For example.
For the women. the most common examples were rugby league and touch football for males and netball for females. In support of the findings of Thompson et al.15 However. many of the men mentioned that they did not walk because they felt they were being judged by others when out in public.10 Data clearly show that Indigenous Australians have children earlier than non-Indigenous Australians. These findings are consistent with those of Thompson and colleagues who reported that Melbourne-based Indigenous people thought about physical activity in three ways: exercise. Some men also spoke about walking. every precaution was taken to ensure that all participants were given the opportunity to contribute to the discussions. competitive sports and everyday activities. raking leaves. Participants in this study readily identified the benefits of physical activity and appropriate forms consistent with the current guidelines. Thus. An interesting point is that domestic duties and household chores when done continuously in lab-based studies do require moderate energy expenditure which can be beneficial in terms of health. Several other issues were identified as barriers to physical activity participation. Bauman and colleagues have previously identified child safety and security issues as barriers to increasing physical activity levels. but mostly outside the home such as yard work.10 Domestic work appeared to be the predominant daily activity undertaken by the female participants. and they did not do as much as they wanted to do. domestic duties and child minding were critical factors influencing their current activity levels. Men in the present study reported much domestic-related activity as well. represent the views of domineering group. but most focused on a desire to play contact sports. identified barriers that need to be overcome and potential strategies suitable for promoting physical activity to urban Indigenous Australians. a number of the women in the present study also reported netball as an activity they had once participated in and would like to be involved with again (if there was a local competition). A number of the participants still had an interest in playing sport but mentioned that there were few opportunities in their area. it is possible that the true meaning of responses may be misinterpreted by a non-Indigenous 106 Health Promotion Journal of Australia 2008: 19 (2) . mowing. Lack of safety also forced a number of parents to keep their children at home. like football. there were often little funds left to support parental participation. If the family could afford to enrol a child in organised sport.14.17 Any attempt to increase physical activity among Indigenous Australians should therefore involve strategies that provide opportunities for the whole family. For population groups and communities on low incomes.8 and this particular sentiment was shared by the participants in this study. Further. and this was especially the case for families.16 and that having a family significantly (and negatively) affects the physical activity levels of the parent (and especially the mother). including that all data were collected via self-report methods. cost is a significant barrier to government agencies trying to promote greater activity levels.13 All groups discussed walking..19 One of the strengths of this study is its relatively large sample (17 groups involving 96 participants). the data may be affected by social desirability bias. competitive team sports.20 or in the case of focus group discussions.g. the findings are limited by a number of factors. This study used a series of focus group discussions to provide some insight into urban Indigenous Australians’ perceptions of physical activity. Many also felt that that there was a need for ongoing programs or opportunities for community participation in regular sporting activities. This is highlighted by the fact they often spoke in reference to activities that they had once participated in more frequently and would do so again (if given the opportunity locally). Many also made mention of activities that involved some element of competition. participation in team sports). One of the main findings from these focus group discussions was that the relationship between physical activity and health appeared to be well understood.Hunt. Marshall and Jenkins Article Discussion As highlighted by Shilton and Brown. despite the powerful rationale for focusing on physical activity in Australia’s Indigenous communities9 there is little information relating to needs and barriers on which to build programs that will be meaningful. relevant and acceptable to Australia’s Indigenous people. However. Another potential limitation of focus group research is that the data are open to the interpretation of the moderator/analyst. However. Cost was another frequently cited barrier to participation. This finding is consistent with previous research conducted with women from different cultures and backgrounds.18 Further acknowledgement and education of the role domestic chores can have in contributing to overall physical activity levels warrants further investigation with Indigenous adults. with many reporting there was little time or energy left for activities of a different nature (e. Perceived neighbourhood safety was also cited as a barrier to participation. etc. While they did not necessarily feel ‘unsafe’. despite the occasional sporting tournament or carnival. family was considered to be extremely important in the context of physical activity. Consistent among both genders was the fact that they recognised the benefits of physical activity. family-orientated activities and domestic chores as types of activities they did or liked to do.
(CA): Sage Publications.7 Suppl 1. Health Educ Behav. Walking was identified as a preferred activity in all groups.1(2):1-4. Canberra (AUST): ABS. 2005. Bellew B. ABS Catalogue No. Brown W. Med J Aust. 1994.au/publications/cvd/hsvd01/ hsvd01-c06. 1999.39-42. participant recruitment was limited to adult urban Indigenous people. The findings of this study clearly emphasise the need to shift in focus away from individual activity pursuits. further research is required to explore issues faced by Indigenous service providers when developing and managing physical activity programs aimed at the local Indigenous population. Finally. Getting Australia Active: Towards Better Practice for the Promotion of Physical Activity. to facilitate sustained intergenerational involvement. Family engagement in activity appeared to be a strong motivator for physical activity as were group-based activities. This was minimised by having an Indigenous researcher moderate the focus groups. Thompson S.pdf 8. mentoring and role modelling are important.21-23 so that a sense of community ownership and control can prevail. Aust J Rural Health. Conclusions The present study has found that Indigenous females identified moderate domestic (household) duties.7(4):229-36. However. 2005. Australia’s Welfare 2005. Australian Bureau of Statistics. Shamdasani P Focus Groups: Theory and Practice.: 4715. and a grant awarded to Dr Marshall from the Commonwealth Department of Health and Ageing. Australian Institute of Health and Welfare [homepage on the Internet]. Exercise in the prevention of coronary heart disease: Today’s best buy in public health. Australian Institute of Health and Welfare. Thousand Oaks . Australian Bureau of Statistics. 1984. The male participants generally identified vigorous outdoor domestic chores and contact sports as physical activity. 1995 [cited 2007 July 5]. Shilton TR. . Diabetes. 1979. This means that the data cannot be generalised to Indigenous people living in rural or remote communities or to urban Indigenous youth. 1990. Maher P A review of traditional Aboriginal Health beliefs. before this recommendation may be realised.: 4704. there remains an absence in the literature of research data necessary to inform effective and sustainable strategies. and/or group walking programs. Thorpe L. Thank you also to the Brisbane Southside Indigenous Public Health Forum who provided feedback and encouragement for the project. 7. The priority of the present research was to understand the particular cultural and social issues and work with the community to develop programs that may be driven from within the community by motivated community members. As well. Initiatives aimed at increasing the activity levels of urban Indigenous Australians should involve the community earlyon. Collectively. O’Dea K.27(6):725-43. Bauman A. 2004. Canberra (AUST): AIHW. Previous research has found that programs are more likely to be successful if developed and implemented by representatives of the Indigenous community.0. Available from: http://www. Marked improvement in carbohydrate and lipid metabolism in diabetic Australian Aborigines after temporary reversion to traditional lifestyle. 6. While there has been an increase in government initiatives in recent years to promote physical activity in Indigenous communities. 4. 2. cost and accessibility.aihw. References 1. Furthermore. the data should not be considered as truly representative of all urban Indigenous populations as the participants in this study were generally well-educated (most had completed high school. 2000. ‘Women’s business’: cultural factors affecting the use of family planning services in an Aboriginal community. Aboriginal and Torres Strait Islander Peoples. Acknowledgements The authors would like to thank the community organisations and groups who assisted in the research and the participants for the time they spent sharing their thoughts with us. Canberra (AUST): AIHW. the findings of this study have the potential for local authorities to develop public health initiatives for Indigenous Australians. Stewart D. However.26(7):807-14. Melbourne (AUST): National Public Health Partnership. Health Promotion Journal of Australia 2008: 19 (2) 107 . and focus on increased opportunities for family-orientated activities. Physical Activity among Aboriginal and Torres Strait Islander people and communities. it has the potential to be a group-based activity (another preference) and is clearly one avenue that should be explored as a way to increase in daily activity levels among urban Indigenous Australians. Morris JN.33:596-603. The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples. 5. Canberra (AUST): ABS. one advantage of using local Indigenous programs and organisations as a way to recruit participants is that the top down support from the community/organisational leaders helped potential participants to feel comfortable about volunteering to participate. analyse the data and interpret the findings of this study. 2006. This research was partially supported by Queensland Health (Brisbane Southside Public Health Unit) which provided a scholarship to Julian Hunt. Gifford S. 2005. 2002. walking and noncontact sports (such as netball) as physical activity. AIHW Catalogue No. National Aboriginal and Torres Strait Islander Health Survey 2004–05. to focus on family and community opportunities. The findings of this research emphasise that activities that are ‘fun’ and engage the whole family are very important. J Sci Med Sport.gov.0. The social and cultural context of risk prevention: food and physical activity in urban Aboriginal community. 10. Owen N.: AUS65. Med Sci Sports Exerc. 11. The main barriers to being more active were the feeling that they were being judged by others when in public spaces. Brown W. 12. 3. Reid J. 9. ABS Catalogue No. and/or attended university) and were recruited from a metropolitan city.Exploring Health Behaviours Promoting physical activity among urban Indigenous Australians person.
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