Review Article

Physical Activity among Adults with Low Socioeconomic Status Living in Industrialized Countries: A Meta-Ethnographic Approach to Understanding Socioecological Complexities

Table 1

Translation of 1st and 2nd order constructs and interpretation through 3rd order constructs.

3rd order labels3rd order constructs2nd order constructsSummary definition (translation) of the 1st and 2nd order constructsSources

Urban planningPoor urban planning leads to inaccessibility of resourcesInaccessibility of resourcesLack of reliable transportation restricts access to neighbourhood recreational facilities, especially for those who live in remote areas. Lack of childcare and inconvenient hours of operation are policy barriers to entry1, 3, 4, 6, 7, 10, 12, 13, 14, 16, 17, 18

Poor urban design and maintenance contributes to negative feelingsPoor neighbourhood aesthetic qualitiesPoor neighbourhood appearances are a disincentive to being active. Poor environment because of poorly maintained footpaths, parks, and roads, in addition to vandalism are visually depressing and make people feel neglected1, 2, 3, 4, 5, 6, 7, 8, 13, 17, 19

People need to feel protected in environmentFear of crime and violenceThreatening situations such as gunshots, vandalism, drug trafficking, muggings, theft, prostitution, and homicide are some reasons why people want more law enforcement and prefer to stay home than exercise outside or even the gym. Threats from gangs, older children, and fear of abduction are on the minds of parents2, 3, 5, 6, 8, 12, 13, 15, 16, 17, 19

Neighbourhood safety hazardsOpportunities for PA are influenced by perceived safety or danger of neighbourhood, i.e., traffic, unleashed dogs, poor lighting at night, homes located on highways, decaying footpaths, people in parks doing drugs, pranks, and obscenities; glass on the floor, dirty needles, and cigarettes are especially concerning for parents1, 2, 3, 4, 5, 6, 12, 13, 16, 17, 19

Financial constraintIncome inequality because of limited choice for PAAffordabilityCost is regarded as a major barrier with equipment and sports clubs’ contributions perceived as too expensive. Expensive drinks after exercise add to increased costs. Childcare and transportation costs also financial barriers8, 11, 12, 13, 14, 16, 19

Recognition of low-cost physical activity alternativesCheaper alternatives for PA are recognised such as subsidies at gyms for low-income people or just running outside3, 11, 16, 17

Inflexible, long-term commitment and unaffordable optionsPricing strategies welcomed but commitments with lengthy memberships can deter people from participating in sports. Perceived stigma for being below poverty line when requesting subsidies also reduces participation11, 16

Work-life integrationWork-life integration coping mechanisms exhausted by personal responsibilitiesPrioritisation of timePersonal responsibilities such as work, school, and family are priorities for time and energy expenditure more than personal needs such as PA. Time constraints because of inflexible work hours and family responsibilities leave inadequate personal time to recover from feelings of exhaustion3, 7, 9, 10, 11, 12, 13, 14, 16, 17, 18

Community engagementCommunity engagement strategies need to personally relate to peopleConventional marketing of programs has limited impactLack of resources, social marketing knowledge, and multilingual skills to communicate about local activities, cause low turn-out and high drop-out rates12, 16
Lack of tailored activities available to connect with communityLanguage difficulties and lack of multilingual resources prevent tailoring of activities but friendly nonjudging socialisation gains trust nonetheless12, 13, 16, 18

Social supportPA is a social experienceLack of social supportSocial influence is a motivator to engage in PA. Support from community networks including friends, parents, family members, coaches, and health professionals provide both encouragement and sense of security2, 6, 8, 10, 11, 13, 14, 15, 16, 17, 19

Lacking an exercise companion not a barrierSome people prefer to exercise alone and not participate in group programs. There are mixed opinions about exercising with co-workers3, 11, 18, 19

People might be in isolation because of family cultureNegative social influencesFeeling of guilt as exercise is considered a selfish and low-priority activity by one’s own family. In addition, weight-related teasing and social misconceptions between different family cultures impedes social interaction within community2, 3, 12, 13, 16, 17

Psychosocial factorsLow self-esteem makes people feel uncomfortable around peersPoor self-imageThinking they are flabby in physical appearance or overweight makes people feel uneasy in fitness clubs with mostly slim and trained people. Body image issues also mean difficulty finding appropriate clothing to wear comfortably in public2, 11, 16, 17, 18

PA is perceived as a coerced experienceTransport-related walking feels like a choreWalking is perceived as a negative experience. As a primary form of transport or incidental activity it is described as an exhaustive and burdening necessity1, 2, 3, 17

Perceived low personal functioningExpectation to participate in certain types of exercises might be inappropriate because of advancing age, chronic health conditions, physical disabilities, poor mental health, fatigue, physical discomfort, or current fitness level2, 9, 10, 13, 17

However, mental health problems not considered a main barrierIssues of boredom and stress, being “stuck in a rut” or embarrassed more acknowledged than health problems for lack of exercise11, 12

People need self-belief through recognised improvementPerceived low physical competencePositive experiences of participation such as parental encouragement or “mastery experience” promote ongoing participation, whereas negative experiences discourage participation2, 3, 18

Bolded indicates key articles most influential in the construct of the summary definition of the first- and second-order constructs.