ABSTRACT
BACKGROUND: One of the most important health determinants is social vulnerability, which can interfere in the practice of physical activity (PA). This study aimed at analyzing adherence to a PA program in a high social vulnerability context. METHODS: A longitudinal study with a 6-month intervention period was conducted. The program offered monitored walks associated with behavioral change educational campaigns. Sociodemographic characteristics, occupation, PA level, noncommunicable chronic diseases, participants' frequency of participation in the program, and intervention dropout reasons were evaluated. Descriptive and survival analyses were accomplished. RESULTS: Among the 106 participants, 88.0% were female and 21.7% were older adults. The most mentioned participation reasons were health improvement (23.0%), weight loss (19.0%), disease control (17.0%), and social living (12%). The mean frequency of participation in the program was 27.4%. Dropout rate was 52.7%. The main reported reasons for dropping out were work hours (27.8%), health problems (25.9%), personal reasons (22.2%), and lack of time (11.1%). Factors associated with remaining in the program were being older adults and presenting body mass index <25 kg/m2. CONCLUSIONS: Results showed that in a high social vulnerability context, adherence to PA programs is low, and adult-life-related commitments and high levels of obesity are factors associated with lower adherence.
Subject(s)
Patient Dropouts/psychology , Patient Dropouts/statistics & numerical data , Social Environment , Walking/physiology , Aged , Body Mass Index , Exercise/physiology , Female , Humans , Longitudinal Studies , Male , Middle Aged , Weight LossABSTRACT
BACKGROUND: The positive health impact of physical activity (PA) is well known, yet a large proportion of the world's population remains sedentary. General PA programs are common as health promotion initiatives. However, effectiveness evaluations of such PA programs on individual and organizational aspects, which could inform the decision-making process of public health bodies are still lacking, particularly in the most socially disadvantaged areas, where health promotion schemes are particularly needed. The aim of this study was to assess the effectiveness of a Guided Walking Program in a high social vulnerability context. METHODS: A quasi-experimental, mixed methods study was conducted. The program had a duration of 6 months and a 6-month follow-up period after the intervention. Session frequency was five times a week, where sessions consisted of supervised PA combined with educational sessions. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was followed to assess the program. The International Physical Activity Questionnaire (IPAQ) and accelerometers were used to measure levels of PA. Focus groups were conducted to gain a comprehensive insight on the implementation domain. RESULTS: Most subjects in the intervention (IG) (n = 74) and control (CG) (n = 74) groups were female (IG:90.5%; CG:95.9%), aged 18-49 years (IG:44.6%; CG:43.2%), received less than 1 minimum wage (IG:74.3%; CG:83.7%) and had 0-4 years of formal education (IG:52.1%; CG:46.1%). The reach of the intervention was 0.3%. The IG showed increased levels of PA at post-intervention and 6-month follow-up. However, the difference between groups was not statistically significant. Adoption data revealed that 89.5% of the professionals in the Primary Health Care Center (health center) team perceived the benefits of the program for the population. The program was independently promoted by the health center team for a further 4 months post-intervention. The qualitative data revealed that the program was discontinued due to participants' low adherence and human resource limitations in the unit's operational dynamics. CONCLUSIONS: A health promotion intervention in a socially deprived setting faces challenges but can be effective and feasible to implement. The present study informs the development of future health promotion initiatives in this context. TRIAL REGISTRATION: NCT02857127 . Registered: 30 July 2016 (retrospectively registered).
Subject(s)
Health Promotion , Poverty Areas , Program Evaluation/methods , Walking , Adolescent , Adult , Brazil , Female , Follow-Up Studies , Humans , Male , Middle Aged , Young AdultABSTRACT
O programa Caminhada Orientada em Unidades de Saúde da Família (USF) ocorre em quatro USFs em um contexto de alta vulnerabilidade social do município de São Carlos, SP, em parceria com a Universidade Federal de São Carlos (UFSCar). O programa visa a promoção de saúde através da prática de exercícios físicos em conjunto com ações educativas de promoção de saúde. A equipe de trabalho é formada por profissionais das USFs, bem como docentes, graduandos e egressos dos cursos de Gerontologia e Educação Física. Resultados gerais mostram que houve um aumento de 87,6 (±10,1) para 204,1 (±23,7) minutos semanais nos domínios de deslocamento e lazer somados. Além disso, 78,5% da equipe de profissionais das USFs relataram se sentir envolvido na aplicação da intervenção. Programas desse modelo podem ser aplicados na Atenção Básica (AB) de Saúde, de modo a garantir a equidade das ações do Sistema Único de Saúde.
The Walking program in Family Health Units (USF) occurs in four Units Health in a context of high social vulnerability of São Carlos, SP, in partnership with the Federal University of São Carlos. The program is aimed at health promotion through physical exercise added with educational activities for health promotion. The team consists of professionals from USF, teachers, undergraduates and graduates of Gerontology and Physical Education. Overall results show that there was an increase of 87.6 (±10.1) to 204.1 (±23.7) minutes per week in transportation and leisure time combined. In addition, 78.5 % of health professional reported feeling involved in applying the intervention. Programs of this model can be applied in the Primary Health Care to ensure the fairness of the actions of the National Health System.
