Older Ghanaian Adults’ Perceptions of Physical Activity: An Exploratory Qualitative Study, Accra, Ghana
What are Ghanaian older adults’ perceptions of physical activity? What are the characteristics of a physical activity program that would be attractive to them?
Like other developing countries, Ghana is experiencing an epidemiologic shift in public health issues. The four leading causes of death as of 2012 were lower respiratory infections, stroke, malaria, and heart disease, presenting a combination of communicable and non-communicable diseases. In Ghana, the incidence of non-communicable diseases is on the rise, with stroke and heart disease rates increasing since 2000.2 Overweight and obesity, a risk factor for stroke and heart disease, is also becoming a growing problem, with rates higher than the average of African countries. Physical activity rates have also been decreasing, coinciding with urbanization and an increase in sedentary work. As a lack of physical activity contributes to overweight / obesity and non-communicable diseases, promoting physical activity can address Ghana’s new public health challenges by preventing non-communicable disease including stroke, heart disease, and obesity.
The Ghanaian Ministry of Health has published physical activity guidelines for older adults, which recommend engaging in 150 minutes of moderate-intensity aerobic activity (or 75 minutes of vigorous-intensity aerobic activity, or an equivalent combination of both) and two sessions of muscle-strengthening activities (targeting major muscle groups) per week. However, 26% of older adults (age 50 and older) in Ghana have low physical activity levels, with a higher prevalence of low physical activity levels in urban residents.
Community-based physical activity intervention are an effective method of helping adults to begin and continue regular physical activity. However, a literature review of community-based older adult physical activity interventions did not identify any interventions in Ghana. While recognizing that physical activity interventions without published results may exist, this nevertheless demonstrates a need for evidence-based physical activity programming. The first step in adapting a physical activity intervention for the Ghanaian older adult population is determining the population’s perceptions of physical activity and the characteristics of a program that would be attractive.
The project will be implemented through a collaboration between the UW Extension Educator (Laura Balis) and the Ghanaian research partner (Godfred Sowatey) with guidance from the senior research partner (Dr. Samantha Harden, Virginia Tech). Focus groups will be used to gather qualitative data from Ghanaian older adults to determine perceptions of physical activity and characteristics of attractive programming. Focus group participants will be recruited through adult church groups in three urban areas: Accra, Cape Coast, and Koforidua. These cities represent three of the twelve largest urban areas in Ghana and each represent a different region of the country (Greater Accra, Central, and Eastern). The semi-structured focus group questions will be developed based on the Theory of Planned Behavior in order to explore attitudes, subjective norms, perceived behavioral controls, and intentions related to physical activity. The Theory of Planned Behavior is a health behavior theory that has been used to explain physical activity behaviors and can be used to develop, implement, and evaluate interventions based on the identified determinants of these behaviors. Focus group questions will also include characteristics of a physical activity program that would be attractive to Ghanaian older adults, including target participants and delivery agents, program location and schedule, delivery methods, and program contents and characteristics. Focus group planning and script development will be completed in partnership with the Ghanaian research partner, who will also serve as the focus group moderator.
Research will be completed by May 2017. Following completion of the project, the focus group data will be coded into themes based on the Theory of Planned Behavior constructs and results will be analyzed. A manuscript will be prepared and submitted for publication, with the Journal of International Agricultural & Extension Education as a target journal.
The results will inform the next stages of this work: adaptation, delivery, and evaluation. First, an evidence-based older adult physical activity program will be adapted to meet the needs of the Ghanaian older adult population. Next, additional funding will be sought to pilot test program delivery in Ghana through a research-practice partnership, an approach designed to improve the translation of research to practice through collaborating with partner organizations that deliver the intervention. A Ghanaian partner organization will be identified in collaboration with the Ghanaian research partner through reviewing focus group data and then conducting key informant interviews with identified local organizations. Finally, the intervention will be evaluated through the RE-AIM framework (reach, efficacy, adoption, implementation, and maintenance) to determine both individual-level and system-level outcomes to enhance the public health impact of the intervention.
Balis, Laura, "Older Ghanaian Adults’ Perceptions of Physical Activity: An Exploratory Qualitative Study, Accra, Ghana" (2017). CGS Faculty Awards 2017. 1.