Maria Horne

What are the barriers and facilitators to exercise and physical activity uptake and adherence among South Asian older adults: a systematic review of qualitative studies.

OBJECTIVE The objective of this study is to synthesise views and experiences of South Asian (SA) older adults in relation to exercise and physical activity (PA). It was anticipated that this work would identify barriers and facilitators that could inform interventions aimed at promoting PA among this population. METHOD A systematic review of qualitative research was conducted. Six electronic databases were searched for relevant papers published from January 2000 to October 2011. Studies were appraised and data extracted by two reviewers. A synthesis was undertaken using framework analysis. Of 26 papers read in full, 11 were included in the review. RESULTS An overriding concept derived from the synthesis was the influence of empowering and disempowering contexts on PA levels of SA participants. It was supported by the following themes: communication (e.g. relying on relatives for translation of information, lack of understanding); relationships (e.g. social support from family, friends, community), beliefs (e.g. not culturally appropriate to exercise, fatalism) and environment (e.g. lack of accessible recreational areas/facilities). CONCLUSIONS Drawing on community resources to generate group norms appears to be important when trying to increase exercise and PA among SA older adults. Implications of the results for PA promotion and provision are discussed.

Patients as teachers? An evaluative study of patients' involvement in classroom teaching

The aim of this study was to evaluate the participation of patients in classroom-based teaching within a pre-registration programme. The rationale for the research was based on the view that utilizing patients as active participants in teaching and learn ing experiences allows nurses to gain valuable insight into the patients perspective by developing a more patient-centred approach to identifying their perceived problems. The study involved three patients and 23 students in the adult branch of their Di ploma in Professional Studies in Nursing (DPSN). Questionnaires were used to elicit responses from students about their experiences of being involved in patient-focused teaching sessions. Case study design is used to describe the organization and involve ment of patients. The findings suggest that involving patients in classroom teaching is an effective teaching strategy for enhancing the teaching and learning experiences of nurses, as well as having positive effects on participating patients. The discus sion raises a number of practical and ethical issues relating to the utilization of patients in classroom teaching.

What do community-dwelling Caucasian and South Asian 60–70 year olds think about exercise for fall prevention?

Background: strategies to prevent falls often recommend regular exercise. However, 40% of over 50s in the UK report less physical activity than is recommended. Even higher rates of sedentary behaviour have been reported among South Asian older adults. Objective: to identify salient beliefs that influence uptake and adherence to exercise for fall prevention among community-dwelling Caucasian and South Asian 60–70 year olds in the UK. Methods: we undertook an ethnographic study using participant observation, 15 focus groups (n = 87; mean age = 65.7 years) and 40 individual semi-structured interviews (mean age = 64.8 years). Data analysis used framework analysis. Results: young older adults do not acknowledge their fall risk and are generally not motivated to exercise to prevent falls. Those who had fallen are more likely to acknowledge risk of future falls. Whilst many of the beliefs about falls and exercise expressed were very similar between Caucasians and South Asians, there was a tendency for South Asians to express fatalistic beliefs more often. Conclusion: fall prevention should not be the focus of strategies to increase uptake and adherence to exercise. The wider benefits of exercise, leading to an active healthy lifestyle should be encouraged.

Multiple Levels of Influence on Older Adults’ Attendance and Adherence to Community Exercise Classes

Purpose: To examine the influence of individual participant, instructor, and group factors on participants’ attendance and adherence to community exercise classes for older adults. Design and Methods: Longitudinal data from 16 instructors, 26 classes, and 193 older participants within those classes (aged 60–100 years) were examined. Data were collected using questionnaires on individual participants’ demographics, attitudes, health perceptions and conditions, and group cohesion. Instructors’ demographics, training, background, experience, attitudes, and personality were collected. Group factors included class type, cost, transport, and whether the class was held in an area of deprivation. Outcomes (attendance/adherence) were collected through attendance records. Results: Multilevel modelling (MLwiN) revealed both instructor and individual participant variables were important in understanding attendance and adherence. Individuals’ housing, education, mental well-being, group cohesion, and attitudes were important predictors of attendance at 3 and 6 months. Instructors’ age, gender, experience, and motivational training were important at 3 months, whereas instructor personality was important at both 3 and 6 months. Having attended longer than 6 months at baseline, participants’ attitudes, weeks offered, instructors’ personality, and experience were associated with adherence at 6 months. Implications: Results suggest that instructors’ characteristics alongside individual participant factors play a role in influencing participants’ attendance to exercise classes. These factors should be considered when setting up new programs.

Attitudes and beliefs to the uptake and maintenance of physical activity among community-dwelling South Asians aged 60-70 years: A qualitative study

OBJECTIVES To identify the attitudes and beliefs associated with the uptake and adherence of physical activity among community-dwelling South Asians aged 60-70 years. STUDY DESIGN A qualitative research study using an ethnographic approach. METHODS Focus groups and in-depth interviews were conducted to explore motivational factors associated with initiating and maintaining physical activity. Data analysis followed the framework approach. RESULTS Health, maintaining independence and social support were important in terms of initiating physical activity. Social support, psychosocial elements of activity, health and integrating physical activity within everyday activities were important for adherence to physical activity. The need for gendered physical activity sessions was important to initiating exercise among Muslim South Asians aged 60-70 years. CONCLUSION Promoting active lifestyles and building physical activity in and around day-to-day activities are important strategies in increasing activity levels. However, the needs for culturally appropriate facilities, peer mentors who could assist those with language barriers, specific tailored advice, advice on integrating physical activity in everyday life and general social support could promote uptake and subsequent adherence among this population group.

Pitfalls, perils and payments: Service user, carers and teaching staff perceptions of the barriers to involvement in nursing education

BACKGROUND There is an impetus to involve service users and carers in the education of nurses and a general consensus in the literature about the benefits that this brings to all involved. Whilst these benefits are well rehearsed in the literature there is little written about the potential barriers to service user and carer involvement in nurse education. OBJECTIVE The objective of this study was to investigate service users, carers and staff views on the potential barriers to becoming engaged in nurse education. DESIGN A qualitative study using focus group discussions (FGD) was used to canvas the views of service users, carers and teaching staff. SETTING A large school of nursing in the North West of England. PARTICIPANTS 38 service users and carers recruited from the North West of England and 23 nursing and midwifery teachers and lecturers. METHODS Focus group discussions were employed as the main data collection method. The data were analysed using thematic analysis. RESULTS Six themes occurred in the data as being negatively associated with potential and actual involvement: not knowing the context of the group, lack of preparation of the group, not being supported, not being allowed to be real, not receiving feedback, not being paid appropriately. CONCLUSIONS The process of involvement is not without difficulties. These data show that some consideration needs to be given to the potential barriers to involvement if the engagement of service users and carers is to be effective.

Old(er) care home residents and sexual/intimate citizenship

ABSTRACT Sexuality and intimacy in care homes for older people are overshadowed by concern with prolonging physical and/or psychological autonomy. When sexuality and intimacy have been addressed in scholarship, this can reflect a sexological focus concerned with how to continue sexual activity with reduced capacity. We review the (Anglophone) academic and practitioner literatures bearing on sexuality and intimacy in relation to older care home residents (though much of this applies to older people generally). We highlight how ageism (or ageist erotophobia), which defines older people as post-sexual, restricts opportunities for the expression of sexuality and intimacy. In doing so, we draw attention to more critical writing that recognises constraints on sexuality and intimacy and indicates solutions to some of the problems identified. We also highlight problems faced by lesbian, gay, bisexual and trans (LGB&T) residents who are doubly excluded from sexual/intimate citizenship because of ageism combined with the heterosexual assumption. Older LGB&T residents/individuals can feel obliged to deny or disguise their identity. We conclude by outlining an agenda for research based on more sociologically informed practitioner-led work.

Falls prevention and the value of exercise: salient beliefs among South asian and white british older adults.

The importance of increasing exercise to prevent falls among older adults remains a key worldwide public health priority. However, older adults do not necessarily take up exercise as a preventative measure for falls. This qualitative study aimed to explore the beliefs of community-dwelling South Asian and White British older adults aged 60 to 70 about falls and exercise for fall prevention through 15 focus groups (n = 87) and 40 in-depth interviews. Data were transcribed verbatim and analyzed using a framework approach. Data analysis identified six salient beliefs that influenced older adults’ intention to exercise for fall prevention. In general, older adults aged 60 to 70 did not acknowledge their risk of falling and were not motivated to exercise simply to help prevent falls. Positive beliefs were found to be an unlikely barrier to taking up exercise for fall prevention for those who had experienced a fall. The implications for health promotion and health professionals with this group of older adults are discussed.

Review of how we should define (and measure) adherence in studies examining older adults' participation in exercise classes.

Exercise classes provide a range of benefits to older adults, reducing risk of illness, promoting functional ability and improving well-being. However, to be effective and achieve long-term outcomes, exercise needs to be maintained. Adherence is poor and reporting of adherence differs considerably between studies. Objective To explore how adherence to exercise classes for older people is defined in the literature and devise a definition for pooling data on adherence in future studies. Design Methodological review of the approaches used to measure adherence. Methods A review of the literature was carried out using narrative synthesis, based on systematic searches of MEDLINE, EMBASE, CINAHL and PsychINFO. 2 investigators identified eligible studies and extracted data independently. Results 37 papers including 34 studies were identified. 7 papers (7 studies) defined adherence as completion (retention). 30 papers (27 studies) identified adherence using attendance records. 12 papers (11 studies) based adherence on duration of exercise and 5 papers (4 studies) specified the intensity with which participants should exercise. Several studies used multiple methods. Conclusions There was little consensus between studies on how adherence should be defined, and even when studies used the same conceptual measure, they measured the concept using different approaches and/or had different cut-off points. Adherence related to health outcomes requires multiple measurements, for example, attendance, duration and intensity. It is important that future studies consider the outcome of the intervention when considering their definition of adherence, and we recommend a series of definitions for future use.

The challenges and opportunities in researching intimacy and sexuality in care homes accommodating older people: a feasibility study.

Abstract Aim To explore the challenges of conducting research on sexuality and intimacy among older care home residents. Background Sexuality and intimacy are neglected in care policies and practices. Design Qualitative analytical study drawing on poststructuralist theorizing. Methods Semi‐structured interviews were conducted with residents and spouses (n = 6) and care staff (n = 16) in two care homes in Northwest England in 2014. The sample was obtained through a network of ‘research‐ready’ care homes. Thematic analysis was used to make sense of narratives with the aid of NVivo10. Results Participant responses highlight the workings of ageist erotophobic discourse that undergirds the assumption of residents (and old people generally) as postsexual. This materialized in reservations about the research ranging from opposition on moral grounds to doubts about its feasibility given the age‐group concerned. However, residents and care home staff can also draw on counter‐discourses that resist/challenge ageist erotophobic thinking, which materialized in methodological and ethical recommendations. Conclusion Participants generally agreed with the principle of the research and made recommendations that could counter/resist ageist erotophobic governance and guide researchers on sampling, style of questioning and communicating with (prospective) study participants on a sensitive subject.