Adebusoye, Busola
(2023)
Predictors of physical activity in school attending adolescents in Lagos State, Nigeria.
PhD thesis, University of Nottingham.
Abstract
Background
Physical activity has been shown to be a significant protective factor for different health outcomes. The World Health Organization (WHO) recommends that children and adolescents should accumulate at least 60 minutes of moderate-to-vigorous-intensity physical activity (MVPA) daily. Africa is rapidly undergoing an unprecedented phase of urbanisation and how to ensure healthy lives for its residents is increasingly becoming an important question. Some of the immediate effects of urbanisation are pressures on existing built environment. Previous reviews have synthesised associations between the built environments and physical activity in children and adolescents, but they have focused on non-African settings. Therefore, the first objective of this PhD study was to present evidence on the built environment constructs that were associated with physical activity among children and adolescents in Africa.
Lagos occupies a unique position in West Africa subregion, as the city with the highest rate of urbanisation. As with most cities that are going through urbanisation, inequitable distribution of resources in different areas of the city affect physical activity. The second objective was to determine the proportion of school attending adolescents that reached the recommended MVPA level in Lagos State, Nigeria and to identify the predictors that were associated with reaching the recommended level. And finally, the third objective was to explore the barriers and facilitators of physical activity among school attending adolescents in Lagos State, Nigeria.
Methods
To achieve the above-mentioned objectives, three inter-related studies were conducted. First, a systematic review, adhering to the JBI methodology, was conducted to synthesise the existing evidence on the association of built environment constructs with physical activity among children and adolescents in Africa. Comprehensive electronic searches of ten databases from inception to 22 October 2021 were conducted to identify relevant published and unpublished studies. Two reviewers independently screened the papers, assessed the quality of the included studies using the JBI standard critical appraisal tool, and extracted data using a pre-piloted form. Where possible, data were synthesised using random effects meta-analyses, with effect sizes reported as mean differences (MD) with 95% confidence intervals (CI). The Grading of Recommendations Assessment, Development and Evaluations (GRADE) was used to assess the certainty of the findings.
Second, a cross-sectional study was conducted among a representative sample of 720 adolescents aged 12-19 years from 20 schools in Lagos State, Nigeria in 2020. A validated physical activity questionnaire (Activity Questionnaire for Adults and Adolescents, AQUAA) was administered to assess MVPA and the predictors assessed were socio-demographic variables, anthropometric measurements, sedentary behaviour, self-efficacy, perceived benefits, and perceived barriers. Third, a qualitative study, using semi-structured interviews, was conducted to explore the views and experiences of 21 decision-makers, who were responsible for planning the physical and health education curriculum in secondary schools in Lagos State, Nigeria, on the barriers and facilitators of physical activity in school attending adolescents.
Results
In the systematic review, of the 10,706 identified records, six cross-sectional studies were included which comprised 4628 children and adolescents. Three of the studies had a high-quality score of 7 out of 8. Seven built environment constructs were reported within the included studies namely, residential density, street connectivity, crime safety, availability of physical activity facilities and infrastructure, walkability, aesthetics, and traffic safety. Three of the constructs were assessed with objective measures. Results from individual studies found significant associations between physical activity and objective measure of traffic safety (Mean difference (MD) 2.63 minutes; 95% Confidence interval (CI) 0.16 to 5.1; one study) and an objective measure of crime safety (MD 2.72 minutes; 95% CI 0.07 to 5.37; one study). No significant associations were found between active transportation and any of the built environment constructs. The GRADE evidence for all the assessed constructs was either low (the built environment constructs may lead to little or no difference in physical activity or active transportation) or very low (it was uncertain whether the built environment constructs affect physical activity).
In the cross-sectional study, complete data was provided by 528 adolescents for the study (73% response rate). The recommended MVPA level was reached by 82.8% (95% CI 79.3–85.7) of the participants. Participants spent a median time of 44 (Inter quartile range (IQR) 12.9, 110) minutes of MVPA per day on household-based activities, followed by school-based activities (median 21.4; IQR 4.3, 50.4), active transportation (median 14.3; IQR 0, 35), sport-based activities (median 8.6; IQR 0, 58.9) and leisure-based activities (median 8.6; IQR 1.1, 34.3). Participants in public schools were four times more likely to meet the recommended MVPA level compared to those in private schools (Odds ratio (OR) 3.97, 95% CI 2.46–6.42).
In the qualitative study, eight themes were identified and explored. The barriers to physical activity were (i)students’ characteristics (ii) parental objections (iii) no prioritisation of physical activity (iv) insufficient resources and (v) challenges with schools’ initiatives. The facilitators to physical activity were (vi) students’ interests (vii) students’ awareness of benefits and (viii) schools’ initiatives.
Conclusion
The evidence base for the association between built environment constructs and physical activity in African settings is limited, with no consistent evidence of an association. Therefore, further high-quality studies should be conducted before firm conclusions can be drawn. Findings from the cross-sectional study suggest that a high proportion of school adolescents met the recommended MVPA level in Lagos State, Nigeria. Additionally, our study suggests that interventions for promoting MVPA should be targeted to private schools. Our study’s finding from the qualitative study can help design interventions to increase physical activity among school attending adolescents in Lagos State, Nigeria.
| Item Type: |
Thesis (University of Nottingham only)
(PhD)
|
| Supervisors: |
Chattopadhyay, Kaushik
Leonardi-Bee, Jo |
| Keywords: |
Physical activity, Systematic review, Survey, Qualitative study, Public health, Lagos, Nigeria, Adolescents |
| Subjects: |
QS-QZ Preclinical sciences (NLM Classification) > QT Physiology |
| Faculties/Schools: |
UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine |
| Item ID: |
73431 |
| Depositing User: |
Adebusoye, Busola
|
| Date Deposited: |
31 Jul 2023 04:40 |
| Last Modified: |
31 Jul 2023 04:40 |
| URI: |
https://eprints.nottingham.ac.uk/id/eprint/73431 |
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