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Socioeconomic Diversity and Physical Activity: Using the Model of Human Occupation to Explore Physical Activity Behaviour

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Socioeconomic Diversity and Physical Activity: Using the Model of Human Occupation to Explore Physical Activity Behaviour Socioeconomic diversity and physical activity: Using the Model of Human Occupation to explore physical activity behaviour Thesis submitted in accordance with the requirements of the University of Liverpool for the degree of Doctor of Philosophy Rosemary Hughes November 2019 Declaration Material in this thesis has not been presented either wholly or in part for any other degree or qualification. Content within this document is a result of my own work, apart from where stated. This thesis describes independent research funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, North West Coast (NIHR CLAHRC NWC). The views expressed are those of the author and not necessarily those of the National Institute for Health Research nor the Department of Health and Social Care. i Acknowledgements I would like to extend my gratitude to staff from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North West Coast (NIHR CLAHRC NWC) for granting the opportunity to complete this PhD. Without their enthusiasm and encouragement this research would not have come to fruition. CLAHRC NWC staff have provided invaluable support and guidance throughout the programme. My thanks also to my academic supervisors, Professor Nefyn Williams, Dr Mark Goodall and Dr John D. Blakey, each of whom have provided insight and guidance according to their individual interests and experience. The research is richer as a result of the synthesis of four diverse professions. ii Contents Declaration ……………………………………………………………………………………………..………………………... i Acknowledgements …………………………………………………………………………….……………………………. ii Contents …………………………………………………………………………………………………………….……………. iii Figures …………………………………………………………………………………………………………………………….… x Tables ………………………………………………………………………………………………………………………….…… xi Glossary of terms ………………………………………………………………………………………………….…………. xii Abstract ………………………………………………………………………….………………………………………………. xiii 1. Introduction: Providing foundations for this research ……………….………………..………….…. 1 1.1 Start at the beginning ……………………………………………………………….………………………………… 1 1.2 Defining health inequalities ……………………………………………………………….……………………….. 1 1.3 Scope of this research ………………………………………………………………………………………….……… 2 1.4 Author’s professional standpoint ……………………………………………………………………….……….. 2 1.5 Physical activity and health ……………………………………………………………………….………………… 3 1.5.1 Physical activity parameters …………………………………………………….………………………………. 3 1.5.2 Health and wellbeing ………………………………………………………….……………………………………. 4 1.6 Encouraging physical activity ……………………………………………………………………….……………… 5 1.6.1 Internal versus external influences ………………………………………………………………………….. 5 1.6.2 Impact of technology on physical activity …………………………………………………….…………… 5 1.7 Health, physical activity and deprivation ……………………………………………….……………………. 6 1.8 Scope and focus of existing literature ……………………………………………………….………………… 7 1.8.1 Preliminary literature search ………………………………………………………………….………………… 7 1.8.2 Literature search research question ……………………………………………………….………………… 8 1.8.3 Search aims and objectives …………………………………………………………………….………………… 8 1.8.4 Search strategy development …………………………………………………………..……………………... 8 1.8.5 Search results selection process …………………………………………………………..………………….. 9 iii Contents 1.8.6 Revised search strategy selection process …………………….…………………………………..…… 10 1.8.7 Reflections upon existing literature ………………………………….……………………………………. 12 1.9 Gap in knowledge ……………………………………………………………….…………………………………….. 17 1.10 Scope and focus of this research …………………………………….………………………………………. 19 1.10.1 Study rationale ……………………………………………………………….……………………………………. 19 1.10.2 Research aims ………………………………………………………….…………………………………………… 19 1.10.3 Research objectives …………………………………………………….……………………………………….. 20 1.10.4 Central research question …………………………………………………………………………………… 20 1.11 Summary: Chapter one …………………………………………………….……………………………………… 20 2. Methodology: Conducting the study ……………….………………………………………………………. 21 2.1 Theoretical framework ………………………………….………………………………………………………….. 21 2.1.1 Interpretive lens …………………………………………….………………………………………………………. 21 2.1.2 Frame of reference ………………………………………………………….…………………………………….. 23 2.2 Study design …………………………………………………………………………….……………………………….. 24 2.2.1 Convergent parallel mixed methods ………………………………….…………………………………… 24 2.2.2 Purpose statement ………………………………………………………………………………………………… 25 2.3 Study sample ……………………………………………………………….……………………………………………. 25 2.3.1 Research population …………………………………………………….………………………………………… 25 2.3.2 Sampling strategy ………………………………………………………………………………………………….. 26 2.3.3 Recruitment target …………………………………………….……………………………………………..…... 29 2.3.4 Recruitment strategy ………………………………………….………………………………………………….. 30 2.3.5 Eligibility criteria ………………………………………………….…………………………………………………. 30 2.3.6 Informed consent ………………………………………………….……………………………………………….. 32 2.3.7 Participant journey …………………………………………….………………………………………………….. 32 2.3.8 Ethical considerations …………………………………………………………………….……………………… 33 iv Contents 2.4 Quantitative data collection …………………………………………………………….……………………….. 34 2.4.1 Demographic questionnaire …………………………………………………………….…………………….. 34 2.4.2 EQ-5D-3L Health questionnaire ……………………………….…………………………………………….. 35 2.4.3 WHO (Five) Well-being Index …………………………………….…………………………………………… 35 2.4.4 International Physical Activity Questionnaire (Long) ………………………….…………………… 36 2.4.5 Physical Activity Neighbourhood Environment Scale ……………………….…………………….. 37 2.4.6 Fitbit Charge HR wrist-worn physical activity monitor ……………………………….…………… 37 2.4.7 i-gotU GT-120 Travel Logger …………………………………………………………………..………………. 39 2.4.8 Open source deprivation data …………………………………………………….…………………………. 39 2.5 Qualitative data collection ………………………….…………………………………………………………….. 40 2.5.1 Semi-structured interview …………………….……………………………………………………………….. 40 2.6 Quantitative data analysis ………………………….…………………………………………………………….. 41 2.7 Qualitative data analysis …………………………….…………………………………………………………….. 41 2.8 Summary: Chapter two …………………………………….………………………………………………………. 45 3. Introducing the sample: Demographics, characteristics and generalisability .……….…. 46 3.1 Sample demographics …………………………………………………………………………….………………… 46 3.2 Participant home locations …………………………………………………………………….…………………. 49 3.3 Sample generalisability ………………………………………………………………………………….………….. 49 3.4 Participant concordance and data snapshot ……………………………………………….…………….. 51 3.5 East and west Wirral sub-group comparison ………………………………………….…………………. 53 3.6 Perceived versus actual physical activity ………………………………………………….…………….…. 53 3.6.1 Self-reported level of physical activity ……………………………………………….…………………… 53 3.6.2 Objectively measured daily steps ………………………………………………….……………………….. 54 3.6.3 Accuracy between self-reported and actual physical activity …………………………………. 57 3.7 Self-reported health and wellbeing ……………………………………………………….………………….. 59 v Contents 3.7.1 Self-reported general health ………………………………………………………….………………………. 59 3.7.2 Perception of health-related challenges ………………….…………………………………………….. 60 3.7.3 Self-reported mental health …………………………………….…………………………………………….. 61 3.7.4 Self-reported wellbeing ………………………………………….………………………………………………. 62 3.8 Perceived neighbourhood activity-friendliness ……………….……………………………………..…. 64 3.8.1 Perception of neighbourhood for supporting physical activity ……………….………………. 64 3.8.2 Perceived safety from neighbourhood crime ……………………………….………………………… 65 3.8.3 Influence of neighbourhood activity-friendliness ……………………….………………………….. 66 3.8.4 Influence of neighbourhood deprivation ……………………………….………………………………. 68 3.9 Summary: Chapter three ………………………………………………………….……………………………….. 70 4. Personal environment and physical activity: Individuality and perception ………….…... 71 4.1 Unique realities ………………………………………………………………………………………….…………….. 71 4.2 Concept 1: Perception of physical activity …………………………………………………….……….….. 73 4.2.1 Nature of personal physical activity …………………………………………………….…………..…….. 73 4.2.2 Physical activity and good health ……………………………………………………….…………………… 74 4.2.3 Physical activity and healthy ageing …………………………………………………..………………….. 77 4.3 Concept 2: Personal daily routine …………………………………………….……………………..………… 78 4.3.1 Working hours and work routine …………………………….……………….………………………….... 78 4.3.2 Habituated daily activity ………………………………………………………….…………………………….. 79 4.3.3 Leisure time physical activity ……………………………………………….………………………………... 80 4.4 Concept 3: Intrinsic motivations ………………………………………….……………………………………. 81 4.4.1 Volition toward physical activity …………………………………………………….………………………. 81 4.4.2 Responsibility for self ………………………………………………………………….…………………………. 82 4.4.3 Awareness of own activity patterns ………………………………………….……………………………. 83 4.5 Summary: Chapter four ………………………………………………………………….…………………………. 84 vi Contents 5. Social environment and physical activity: Companionship and cohesion ………..……….. 86 5.1 Social creatures …………………………………………………………………………………………….…………… 86 5.2 Concept 1: Early social experiences …………………………………………………………………….…….. 87 5.2.1 School days and learned behaviour …………………………………………………….………..……….. 87 5.3 Concept 2: Responsibility for others …………………………………………………….…………………… 89 5.3.1 Caring responsibilities ……………………………………………….………….……………………………….. 89 5.3.2 Dog ownership responsibilities …………………………………………….………………………………... 90 5.4 Concept 3: Companionship ………………………………………………….……………………………………. 91 5.4.1 Physical activity in company ……………………………………………….………………………………….. 91 5.4.2 Competition with self and others ………………………….……………………………………………..… 92 5.4.3 Physical activity through
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