The relative influence of individual, social and physical environment determinants of physical activity

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Abstract

Environmental determinants of health are receiving growing attention in the literature, although there is little empirical research in this area. The Study on Environmental and Individual Determinants of Physical Activity (known as the SEID project) was a social ecological project that examined the relative influence of individual, social environmental and physical environmental determinants of recreational physical activity. It involved a community survey of 1803 healthy workers and home-makers aged 18–59 years living in a 408 km2 area of metropolitan Perth, Western Australia. Physical environmental determinants were mainly conceptualised as spatial access to popular recreational facilities. Overall, 59% of respondents exercised as recommended. Recreational facilities located near home were used by more respondents than facilities located elsewhere. The most frequently used facilities were informal: the streets (45.6%); public open space (28.8%) and the beach (22.7%). The physical environment's directs the influence on exercising as recommended was found to be secondary to individual and social environmental determinants. Nevertheless, accessible facilities determined whether or not they were used and in this way, support and enhance the achievement of recommended levels of physical activity behaviour by providing opportunities. The results suggest that access to a supportive physical environment is necessary, but may be insufficient to increase recommended levels of physical activity in the community. Complementary strategies are required that aim to influence individual and social environmental factors. Given the popularity of walking in the community, it is recommended that greater emphasis be placed on creating streetscapes that enhance walking for recreation and transport.

Introduction

Physical inactivity is an important determinant of ill-health, and even moderate levels of activity confer health benefit (US Department of Health and Human Services, 1996). Until relatively recently, behavioural physical activity research has focussed on identifying individual determinants. This approach has been criticised because it places undue emphasis on the individual and fails to consider the context within which health behaviour takes place (Milio, 1986; McLeroy, Bibeau, Steckler, & Glanz, 1988; Tesh, 1988; Minkler, 1989; Stevenson & Burke, 1992; Stokols, 1992). A focus on broader determinants of health behaviour is consistent with a social ecological perspective of human behaviour which suggests an interaction between the individual and the social and physical environment and the need to maximise the ‘person-environment fit’ (Stokols, 1996).

Since the late 1980s, there has been a growing interest in the role of the physical environment in increasing community physical activity levels (Dishman, 1988; King et al., 1995; Sallis, Bauman, & Pratt, 1998). The physical environment provides cues and opportunities for physical activity. Its influence is passive through the design of the urban environment, domestic appliances and buildings which encourage or discourage incidental physical activity (King et al., 1995; Sallis & Owen, 1996; Sallis et al., 1998). Its influence is also active by providing physical activity opportunities that are accessible, convenient, safe and appealing (King et al., 1995; Sallis & Owen, 1996). Compared with individual determinants of physical activity, relatively few studies have examined the influence of the physical environment on physical activity levels (see Brownell, Stunkard, & Albaum, 1980; Hofstetter, Hovell, & Sallis, 1990; Sallis et al., 1990; Linenger, Chesson, & Nice, 1991; McKenzie, Sallis, Nader, Broyles, & Nelson, 1992; Macintyre, Maciver, & Sooman, 1993; Hahn & Craythorn, 1994; Blamey, Mutrie, & Aitchison, 1995; Bauman & Smith, 1999).

The results reported in this paper are based on the Study on Environmental and Individual Determinants of Physical Activity (known as SEID), a social ecological project that examined the relative influence of social environmental, physical environmental and individual factors on recreational physical activity. The overall aims of the research were to measure the individual, social and physical environmental factors influencing participation in planned recreational physical activity and to examine the relative influence of and interaction between, environmental and individual factors that influence exercising as recommended. This paper describes the overall results, as well as the influence of spatial access on the use of recreational facilities.

The individual factors examined in this study were based on the Theory of Planned Behaviour (TPB) (Ajzen, 1991) and the Theory of Trying (TT) (Bagozzi & Warshaw, 1990). These theories are derived from Fishbein and Azjen's theory of reasoned action (TRA), an ‘expectancy-value’ model (Ajzen & Fishbein, 1980). According to expectancy-value models, individuals are more motivated to perform behaviours they believe will result in highly valued outcomes, and, conversely, are less motivated when they do not believe that valued outcomes will follow when the expected outcomes are not valued (Ajzen & Fishbein, 1980).

While the TRA has had widespread use in physical activity research (for example see Godin, 1993; Blue, 1995), its predictive capacity has been limited by the theory's underlying assumption that performing a behaviour involves a rational decision-making process and its performance is under the individual's volitional control. This requires that individuals have all the necessary resources, skills and abilities to perform the behaviour at will, and its execution requires no co-operation from anyone else nor is it subject to any environmental barriers (Ajzen, 1985; Sheppard et al., 1988; Bagozzi & Warshaw, 1990; Ajzen, 1991).

During the 1980s, behavioural scientists questioned the assumption that many behaviours are under an individual's ‘complete volitional control’ (Ajzen, 1985; Bagozzi & Warshaw, 1990) and suggested that, where there is incomplete control, individuals form intentions to perform behavioural goals. Thus, many intentions are best considered goals, the attainment of which are subject to some degree of uncertainty (Ajzen & Madden, 1986).

In the early 1990s, the TPB (Ajzen, 1991) and the TT (Bagozzi & Warshaw, 1990) were developed in response to these concerns. Ajzen's TPB extended the original theory by adding perceived behavioural control: one's belief about how easy or difficult performance of a behaviour is likely to be. Similar to Bandura's concept of self-efficacy (1997), the addition of perceived behavioural control significantly improved the predictive ability of the original theory (Ajzen, 1991).

According to Bagozzi and Warshaw (1990), for most behaviours, the key assumptions of the TRA cannot be met; that is the performance of a behaviour is preceded by a deliberate process culminating in a conscious decision to act and that, once decided, there are no barriers (e.g., cost, inconvenience) preventing action. They developed the TT to better understand the steps between intention formation and actual performance of the target behaviour. Thus, the individual factors examined in this study were based on Bagozzi and Warshaw's (1990) TT, Ajzen's (1985) perceived behavioural control and Bandura's (1997) conceptualisation of behavioural skills.

The limited number of published studies on the influence of the physical environment on physical activity suggest that spatial access to recreational facilities may influence physical activity participation. Spatial access was a significant predictor of participation in an executive health program (Teraslinna, Partanen, Koskela, & Oja, 1969), and had a measurable, albeit modest, impact on participation in vigorous exercise in community settings (Sallis et al., 1990) and on fitness levels in a naval setting (Linenger et al., 1991). Bauman et al. (1999) found that living in close proximity to the coast was associated with exercising as recommended. Convenience appears to be important. Andrew et al. (1981) found that perceptions of the convenience of a rehabilitation program and difficulties encountered with parking influenced participation by post-coronary patients. Indeed, Hofstetter et al. (1990) have reported that positive perceptions about the convenience of facilities and neighbourhood safety increased exercise self-efficacy, a factor known to influence intention to be physically active.

While it has been suggested that the finding that close proximity is associated with the use of facilities could ‘be easily understood by common sense’ (Teraslinna et al., 1969), conclusive evidence that simply having access to facilities increases regular physical activity remains elusive. Sallis et al. (1990) found that enhanced access was associated with higher levels of participation in vigorous activity regardless of one's socioeconomic status. Consequently, Scottish findings (Macintyre et al., 1993) demonstrating an inequitable distribution in recreational facilities in favour of high socioeconomic status suburbs raise concerns that poor access in disadvantaged areas contributes to lower levels of participation in physical activity (Macintyre et al., 1993; King et al., 1995).

Geographers conceive accessibility as a measure of the spatial distribution of facilities adjusted for the desire and the ability of people to overcome ‘spatial separation’ (i.e., distance or travel time) to access a facility or activity (Hansen, 1959). Accordingly, desire and ability are influenced by the importance of the trip to the user (i.e., the felt need), attractiveness of the facility (e.g., the facility's attributes), the facility's location and the user's access to transport (Hansen, 1959). Although it has been demonstrated that use is inversely related to distance travelled, the extent of the distance of decay factor depends upon the attractiveness of the destination, as well as the nature of the trip and its importance to the user.

One approach to measuring accessibility is based on a variation of the gravity model (Hansen, 1959) such thatAi=jmj/dijβ,where Ai is a measure of accessibility from origin i; mj is the attractiveness of destination j; dij is the travel time or distance between origin i and destination j; and β is an estimated destination-specific distance-decay parameter between i and j.

Distance is generally perceived to be a barrier to use a facility, with those living closer having increased opportunities for use and paying less for transport (Knox, 1978). However, in some instances, the effect of distance may be moderated by the attractiveness of a facility or activity and its proximity to other facilities or activities (i.e., its spatial structure) (Fotheringham, 1981; Kim & Fesenmaier, 1990). Measures of attractiveness appear to be context-specific and aspects of attractiveness vary in surveys depending on the type of recreation. For example, in a survey examining recreational travel to regional parks, attractiveness factors included the size of the park, the size of the water body, the availability of boat ramps, opportunities for swimming, and the number of campsites (Kim & Fesenmaier, 1990). In a study of urban swimming pools, attractiveness included the size of the pool, facilities offered and the level of crowding anticipated by individuals (Goodchild & Booth, 1980).

Although the recreational studies reviewed were based on gravity models, none sought to examine individual spatial access. Rather, the objectives were to make decisions about the location of future urban recreational facilities (Goodchild & Booth, 1980); or to evaluate the effects of ‘spatial structure’ (i.e., proximity to nearby recreational opportunities) as a means of understanding the ‘competitive and agglomerative relationship’ between tourism facilities (Kim & Fesenmaier, 1990) or to model recreational trip distribution (Baxter & Ewing, 1981).

Similarly, there appears to be no published examples of the use of models to assess the individual accessibility of recreational facilities. Generally, researchers have examined the ease of access of population groups living in different areas (Knox, 1978). Examining spatial access of population groups assumes that every individual living in a study area has an equal share of the opportunities, regardless of exactly where they live. The extent to which there are individual variations in spatial access within a group and the ability to take-up available opportunities, is not considered in this approach.

Thus, in this study, individual spatial access to nine facilities commonly used by Australian adults for recreational physical activity (DASETT, 1988; DASET, 1992) was examined: six formal facilities (gym or health club; swimming pool; sporting complex or recreation centre; tennis court; golf course or other (e.g., yacht and sailing clubs, squash or badminton courts); and three informal facilities (public open space, river and beach)). It was beyond the scope of this study to examine the factors that made each of these facilities ‘attractive’, although factors that made public open space attractive were considered (Corti, 1998; Broomhall, 1996). Thus, it is assumed that all other facilities are equally attractive.

Section snippets

Study design

The results reported are based on a cross-sectional survey of adults aged 18–59 years undertaken between August 1995 and March 1996. A probability cluster sample was drawn by the Australian Bureau of Statistics. One eligible respondent was randomly selected from each household (the eligible person whose birthday fell closest to the day of the interview was selected). After allowing for three call-backs, a response rate of 52.9% of households was achieved. The final sample included 1803

Physical activity behaviour

In the two weeks before the survey, approximately one-half of all respondents reported participating in vigorous physical activity (47.8%), a similar proportion that participated in light to moderate (52.5%) physical activity, while 82.5% walked for either or both transport (72.1%) and recreation (68.5%). Overall, 59.2% of respondents exercised as recommended (see Table 2). The prevalence in women was 0.90 (95% CI 0.83–0.98) of that in men; and in households with one or more children it was

Discussion

This study found that the influence of individual and social environmental determinants outweighed the role played by physical environmental determinants of exercising as recommended. Nevertheless, access to recreational facilities determined whether or not they were used, and in this way, support and enhance the achievement of recommended levels of physical activity behaviour by providing opportunities. Individual and social environmental determinants on the other hand, appeared more important

Conclusion

Based on the findings of this study, it is tempting to conclude that the physical environment may be of limited importance to achieve overall recommended levels of physical activity in the community. Such a conclusion would be premature given the limitations of the approach taken in this study and the early stage of development of methods to study environmental determinants of behaviour. Moreover, in accordance with health promotion rhetoric, this study found that accessible recreational

Acknowledgements

The Western Australian Health Promotion Foundation (Healthway) provided funding for this project. A number of colleagues from the Department of Public Health provided advice in relation to the spatial access component of this study including Ms Jilda Hyndman (road network analysis) Dr. John Bass, Dr. Richard Parsons, Ms. Diana Rosman, Mr. Mark Divitini and Mr. Michael Winter. Mr. David Blackmore also provided advice. Dr. Ray James provided editorial advice for this manuscript.

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