Introduction

Participating in physical activity [1] and engaging in lower levels of sedentary behavior [2] (i.e. sitting behaviors that expend very low levels of energy (1–1.5 METS) [3]) have been found to be independently associated with a lower risk of chronic diseases such as obesity, type 2 diabetes, and cardiovascular disease. Women living in socioeconomically disadvantaged neighborhoods are at an increased risk of physical inactivity [4], [5] and also of engaging in greater amounts of sedentary behavior [6], [7], independent of individual level socioeconomic indicators. For example, those living in the most disadvantaged neighborhoods have been found to spend on average 28 hours per week engaged in screen time (i.e. television viewing and computer use - the most common leisure-time sedentary behaviours), which is an additional 7 hours per week compared to those living in neighborhoods of high socioeconomic position [6]. These inequities may be partly explained by disadvantaged neighborhoods having poorer urban design [5], poorer accessibility of facilities and higher perceived levels of crime [8] compared to more advantaged neighborhoods. Since inactivity-related illnesses have also been linked to living in socioeconomically disadvantaged neighborhoods [9], [10], [11] it is important to identify effective intervention strategies to increase physical activity and reduce sedentary behavior amongst this high risk group.

Little research has aimed to investigate the most effective strategies to increase physical activity interventions amongst women living in socioeconomically disadvantaged neighborhoods [12], and of the existing intervention evidence in this and other disadvantaged target groups, most studies have focussed on women in the United States from racial/ethnic minority backgrounds [13]. Further, although print-based materials have generally been useful as support strategies for increasing physical activity in adults [14], the feasibility of print-based materials to increase physical activity specifically amongst women living in socioeconomically disadvantaged neighborhoods is not known.

There has been increasing interest in recent years in web-based physical activity interventions [15] with several being found to be successful in increasing women’s physical activity levels [16], [17]. Although programs such as the Women’s Active Living Kits (WALK) Pilot Program [18] have used web-based components to promote physical activity amongst ‘priority groups’ of women (including women with young children, older women, and culturally and linguistically diverse groups), to date, no web-based physical activity interventions have been designed specifically for, and assessed among women living in socioeconomically disadvantaged neighbourhoods. Very few intervention strategies have aimed to reduce sedentary behavior (as opposed to only increasing physical activity) in adults, let alone women living in socio-economically disadvantaged neighborhoods [19], [20]. Of the small number of intervention studies that have targeted reductions in sedentary behavior amongst adults, a large proportion included strategies that were predominantly focused on changing physical activity behavior [21], [22]. To our knowledge, no previous studies have tested the perceived feasibility and effectiveness of intervention strategies aimed at increasing physical activity and reducing sedentary behavior amongst women living in socio-economically disadvantaged areas.

This study aimed to investigate the perceived feasibility of two proposed intervention approaches (one print-based and one web-based) designed to promote physical activity and reduce sedentary behavior amongst women living in socio-economically disadvantaged areas. Further, the study aimed to investigate the feasibility of the two proposed intervention strategies amongst a small sample of key stakeholders representing public policy, health promotion, and community health and well-being. The development of the intervention strategies in this study were informed by a previous study of women living in disadvantaged neighborhoods with depressive symptoms, whereby women identified several potential strategies that they felt would help increase their levels of physical activity and reduce sedentary behavior [23]. Potential strategies included: the provision of information on available facilities to be active in the neighborhood; wider variety of classes/facilities and social exercise groups; awareness-raising of the benefits of physical activity; learning time management skills; provision of childcare facilities (e.g. more one-hour care facilities); and new mother’s exercise groups. Similar strategies (e.g. information/education, variety of activities/classes and social activities) have also been previously suggested by ‘priority groups’ of women who had participated in the WALK Pilot Program [24]. Since qualitative methods are useful for investigating areas in which little is known, the qualitative design of the current study was selected in order to provide rich insights for the development of feasible strategies to promote physical activity and reduce sedentary behavior amongst women living in disadvantaged neighborhoods.

Methods

Results

The final sample consisted of 37 women and five key stakeholders. The mean age of participants was 50 years. Two-thirds of the sample were in a married or defacto (i.e. living with their partner) relationship (65%) and 40% of women had children living at home. Just over half of the women were employed part-time or full-time with just under one-quarter of women retired (22%). About 10% reported a low level of education (had not completed secondary education), 38% a medium level (completed year 12 and/or vocational training), and half had a university degree (51%). All five key stakeholders were women who worked in managerial roles representing local government, a neighborhood/community house, a local gym, a specialised personal training business, and a community health centre.

Of the physical activity undertaken in leisure-time, women spent on average 2.75 hours walking in the last 7 days and 1.75 hours in other moderate and vigorous-intensity physical activity in the previous week. Participants reported approximately 31 hours in the previous week sitting during leisure-time (∼4.5 hr/day).

Discussion

The aim of the current study was to investigate the perceived feasibility of two proposed intervention approaches (one print-based and one web-based) designed to promote physical activity and reduce sedentary behavior amongst women living in socio-economically disadvantaged neighborhoods. Furthermore, the study aimed to investigate the feasibility of the two proposed intervention strategies amongst a small sample of key stakeholders.

The information booklet was perceived by women and key stakeholders as a potentially feasible strategy to increase physical activity and reduce sedentary behavior. Since living in socio-economically disadvantaged neighborhoods is generally associated with lower education (including literacy) levels [36], the information booklet used in the current study was designed to ensure good readability, with the use of simple language and pictures. Most participants suggested that the information booklet was easy to read/understand and well presented. Self-instructional reading (information) materials have been suggested to be an effective and cost-effective strategy for increasing walking amongst disadvantaged women [37], provided that information is presented in a comprehensible style.

A common theme that emerged from the current study was the women’s desire for weight loss tools and information (e.g. diet tips, calorie counters) to be included within both the information booklet as well as the online activity calendar. Since women living in socio-economically disadvantaged neighborhoods are at a greater risk of overweight and obesity than women more advantaged neighborhoods [9], this may be an important component that could provide additional motivation in interventions amongst these women. A number of information-based weight-loss interventions in the general population have been effective in increasing physical activity [38] as well as facilitating weight loss [39] which provides further impetus for testing such strategies within a sample of women living in disadvantaged neighborhoods.

A small number of women suggested that the booklet lacked information relevant to their personal needs, age and/or lifestyle. Individual tailoring of information has been found to be a successful strategy for increasing physical activity as it increases the personal relevance of physical activity interventions for various sub-groups [40]. The findings of the current study indicate that tailoring booklets to various age-groups may be more appropriate. Nonetheless, exhaustive searches of local facilities were conducted, and to our knowledge, all local physical activity recreational clubs, classes and facilities were included in the booklet, suggesting that there may be a real lack of access and opportunities for older and working women to be physically active in the targeted neighborhood. Consistent with previous research [41] suggesting that community-wide physical activity promotion strategies are more likely to be successful when tailored to the attributes of target groups, findings of this study suggested that tailoring delivery methods of the booklet to suit different women’s needs, lifestyles and ages may also be important.

Several women and key stakeholders suggested that the tips provided to reduce sedentary behavior, such as standing at your computer, were impractical and unrealistic. Further, very few women were able to suggest ideas on other information that may help them reduce their sedentary behavior. The concept of reducing sedentary behavior for health benefits is a relatively new area of research and public health focus, and therefore a large proportion of the population may be unfamiliar with it. It is therefore important to promote more broadly the independent health risks linked to engaging in long periods of sedentary behavior, for instance through large scale mass media and social marketing campaigns.

The information booklet was perceived as the preferred and most feasible strategy for increasing physical activity and reducing sedentary behavior amongst the women. However, a number of women saw the value in both intervention strategies and felt that both the information booklet and the online activity calendar should be used together and would complement each other. Previous research comparing print and web-based physical activity interventions has found both strategies to be effective in increasing physical activity in adults [42]. However, one intervention study in the general population [43] reported participants receiving a print-based strategy increased their physical activity levels, yet participants receiving a web-based strategy decreased their sedentary behavior at the end of the study. Consistent with previous recommendations for children and adults [29], the findings of our study suggest that a multi-component approach may be the most successful method to increase physical activity and reduce sedentary behavior amongst women living in disadvantaged neighborhoods.

A major strength of the current study was the qualitative design, which provided detailed insights not possible from quantitative approaches. Furthermore, the inclusion of women from socio-economically disadvantaged neighborhoods in this study provided novel insights in an important group at risk of physical inactivity [44], [45]. Moreover, the current study tested the feasibility of ‘minimal’ intervention strategies that may be widely distributed to large numbers of people, as well as being relatively inexpensive and non-intensive [37]. Thus, these strategies may be more appropriate to implement within socioeconomically disadvantaged communities than more expensive or intensive strategies.

When interpreting the results of this study, a number of limitations should be considered. Firstly, socio-economic disadvantage was defined using an area-based measure. Therefore, a number of participants may not be considered to be socio-economically disadvantaged based on individual level indicators such as income or education. Nevertheless, area-based indicators of disadvantage have been linked to lower leisure-time physical activity, independent of individual socio-economic indicators [5]. Secondly, a number of the women in the current study were already quite active. The recruitment of an inactive sample may have yielded different results. Finally, the current study initially targeted a high-risk and typically hard to reach group (women living in socio-economically disadvantaged neighborhoods). Therefore, it was not surprising that the study had a very low response rate (5%). The recruitment strategies adopted in this study (large, non-personally tailored mail-out) have been used in previous studies of disadvantaged adults; however, generally they have been used in conjunction with other recruitment methods [46]. One recent study suggested that alternative recruitment strategies such as working with community leaders who can help seek out potential participants and using ‘word of mouth’ may be effective for recruiting socio-economically disadvantaged populations [47]. However, further studies are needed to identify the most effective recruitment strategies for reaching such a high-risk and hard-to-reach target group.