Cornelia Guell

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

BackgroundThe 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.Method19 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.ResultsFive 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.ConclusionsTo 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.

Picturing commuting: photovoice and seeking well-being in everyday travel:

We used participant-produced photography to investigate everyday commuting practices in Cambridge, UK. Photovoice served as an observational method for producing ethnographically rich data. A total of 19 participants produced over 500 photos about their journeys to and from work and took part in photo-elicitation interviews. Three themes emerged. First, many images depicted ‘well-being’ in commuting, for example, beautiful landscapes. Second, during elicitation interviews, participants described positive images that they intended but failed to capture in photos. Third, those participants who did not depict well-being described a lack of choice in their commuting, while those who acknowledged well-being seemed to do so in order to make practices of commuting meaningful and habitable. While our interpretations of photos of well-being could be subject to a methodological fallacy relating to a preference for positive over negative images in lay photography, we nonetheless suggest that the rich visual and oral narratives indicate a ‘real’ experience, albeit elicited through the photovoice.

Painful Childhood: Children Living With Juvenile Arthritis:

In this article the author explores the everyday life and coping of children living with juvenile arthritis. The author considered the children as experts on their illness who can give valuable insights into illness management from a patients perspective. This is in contrast to most research, which lets others, such as caregivers, speak in the place of children. She used an ethnographic approach with open-ended interviews and participant observation to capture the complexity of chronic illnesss impact on everyday life. Results of the study indicate that living with juvenile arthritis entails a constant taking control over ones body and achieving normality in life. These children must negotiate between their protected status of being a sick child and their immense responsibility in illness management. The author suggests that existing research on adult chronic illness has only limited relevance to understanding childrens illness experience and that further research with children is needed.

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

BackgroundPerceptions 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.MethodsThis 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.Results340 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.ConclusionsParticipants 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.

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

BackgroundPhysical 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.MethodsA 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.ResultsThree 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.ConclusionsInterventions 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.

Female gender is a social determinant of diabetes in the Caribbean: a systematic review and meta-analysis.

Background Diabetes (DM) is estimated to affect 10–15% of the adult population in the Caribbean. Preventive efforts require population wide measures to address its social determinants. We undertook a systematic review to determine current knowledge about the social distribution of diabetes, its risk factors and major complications in the Caribbean. This paper describes our findings on the distribution by gender. Methods We searched Medline, Embase and five databases through the Virtual Health Library, for Caribbean studies published between 2007 and 2013 that described the distribution by gender for: known risk factors for Type 2 DM, prevalence of DM, and DM control or complications. PRISMA guidance on reporting systematic reviews on health equity was followed. Only quantitative studies (n>50) were included; each was assessed for risk of bias. Meta-analyses were performed, where appropriate, on studies with a low or medium risk of bias, using random effects models. Results We found 50 articles from 27 studies, yielding 118 relationships between gender and the outcomes. Women were more likely to have DM, obesity, be less physically active but less likely to smoke. In meta-analyses of good quality population-based studies odds ratios for women vs. men for DM, obesity and smoking were: 1.65 (95% CI 1.43, 1.91), 3.10 (2.43, 3.94), and 0.24 (0.17, 0.34). Three studies found men more likely to have better glycaemic control but only one achieved statistical significance. Conclusion and Implications Female gender is a determinant of DM prevalence in the Caribbean. In the vast majority of world regions women are at a similar or lower risk of type 2 diabetes than men, even when obesity is higher in women. Caribbean female excess of diabetes may be due to a much greater excess of risk factors in women, especially obesity. These findings have major implications for preventive policies and research.

Policy initiatives, culture and the prevention and control of chronic non-communicable diseases (NCDs) in the Caribbean

Objective. To explore interactions between disease burden, culture and the policy response to non-communicable diseases (NCDs) within the Caribbean, a region with some of the highest prevalence rates, morbidity and mortality from NCDs in the Americas. Methods. We undertook a wide ranging narrative review, drawing on a variety of peer reviewed, government and intergovernmental literature. Results. Although the Caribbean is highly diverse, linguistically and ethnically, it is possible to show how ‘culture’ at the macro-level has been shaped by shared historic, economic and political experiences and ties. We suggest four broad groupings of countries: the English-speaking Caribbean Community (CARICOM); the small island states that are still colonies or departments of colonial powers; three large-Spanish speaking countries; and Haiti, which although part of CARICOM is culturally distinct. We explore how NCD health policies in the region stem from and are influenced by the broad characteristics of these groupings, albeit played out in varied ways in individual countries. For example, the Port of Spain declaration (2007) on NCDs can be understood as the product of the co-operative and collaborative relationships with CARICOM, which are based on a shared broad culture. We note, however, that studies investigating the relationships between the formation of NCD policy and culture (at any level) are scarce. Conclusion. Within the Caribbean region it is possible to discern relationships between culture at the macro-level and the formation of NCD policy. However, there is little work that directly assesses the interactions between culture and NCD policy formation. The Caribbean with its cultural diversity and high burden of NCDs provides an ideal environment within which to undertake further studies to better understand the interactions between culture and health policy formation.

‘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.

From the concrete to the intangible: understanding the diverse experiences and impacts of new transport infrastructure

BackgroundChanges to the environment that support active travel have the potential to increase population physical activity. The Cambridgeshire Guided Busway is an example of such an intervention that provides new traffic-free infrastructure for walking, cycling and public transport. This qualitative investigation explored the diverse experiences of new transport infrastructure and its impacts on active travel behaviours.MethodsThirty-eight adult participants from the Commuting and Health in Cambridge natural experimental study were purposively selected according to their demographic and travel behaviour change characteristics and invited to participate in semi-structured interviews between February and June 2013. A mixed-method, following-a-thread approach was used to construct two contrasting vignettes (stories) to which the participants were asked to respond as part of the interviews. Inductive thematic qualitative analysis of the interview data was performed with the aid of QSR NVivo8.ResultsPerceptions of the busway’s attributes were important in shaping responses to it. Some participants rarely considered the new transport infrastructure or described it as unappealing because of its inaccessibility or inconvenient routing. Others located more conveniently for access points experienced the new infrastructure as an attractive travel option. Likewise, the guided buses and adjacent path presented ambiguous spaces which were received in different ways, depending on travel preferences. While new features such as on board internet access or off-road cycling were appreciated, shortcomings such as overcrowded buses or a lack of path lighting were barriers to use. The process of adapting to the environmental change was discussed in terms of planning and trialling new behaviours. The establishment of the busway in commuting patterns appeared to be influenced by whether the anticipated benefits of change were realised.ConclusionsThis study examined the diverse responses to an environmental intervention that may help to explain small or conflicting aggregate effects in quantitative outcome evaluation studies. Place and space features, including accessibility, convenience, pleasantness and safety relative to the alternative options were important for the acceptance of the busway. Our findings show how environmental change supporting active travel and public transport can encourage behaviour change for some people in certain circumstances.

Walking groups in socioeconomically deprived communities: A qualitative study using photo elicitation

Walking groups can benefit health but uptake is more likely amongst those who are socially well-situated and need them least. This study worked with a new walking group in a community in England with poor health and socio-economic indicators to understand non-participation and barriers to involvement. It used a qualitative approach. Participant generated photographs captured the physical and social environments in which they walked and these were used with semi-structured interviews to inductively explore walking group participation and the wider social context of walking. We found that prior to joining there were low expectations of any health benefit and walking groups were not viewed as ‘proper’ activity. The group format and social expectations presented a barrier to joining. Having joined participants described a developing awareness of the health benefits of walking. The shared sense of achieving health goals with others sustained the group rather than socialising, per se. We suggest that walking group participation is a complex social practice. Promoting walking groups as a social activity for this group of people may well have been counter-productive.