BARRIERS AND ENABLERS TO PHYSICAL ACTIVITY BEHAVIOUR IN OLDER ADULTS DURING HOSPITAL STAY: A QUALITATIVE STUDY

H.C. van Dijk - Huisman^1,2, P.H. Raeven-Eijkenboom³, F.J.H. Magdelijns⁴, J.M. Sieben^2,5, R.A. de Bie^2,6, A.F. Lenssen^1,2

¹Maastricht University Medical Center, Department of Physiotherapy, Maastricht, Netherlands, ²Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, Netherlands, ³Avans University of Applied Sciences, Breda, Netherlands, ⁴Maastricht University Medical Center, Department of Internal Medicine, Division of General Medicine and Clinical Geriatric Medicine, Maastricht, Netherlands, ⁵Maastricht University, Department of Anatomy & Embryology, Maastricht, Netherlands, ⁶Maastricht University, Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care, Maastricht, Netherlands

Background: Low physical activity levels are common in older adults during hospitalisation and have been associated with negative health outcomes. Understanding which barriers and enablers influence the physical activity behaviour of hospitalised older adults is a first step towards identifying potentially modifiable factors and developing, evaluating and implementing targeted interventions aimed at increasing their physical activity levels. Using a theoretical framework has been found to be more successful in changing behaviour than using a non-theory driven approach.

Purpose: The purpose of this study was to explore barriers and enablers to physical activity in older adults admitted to a hospital with an acute medical illness, as perceived by patients and healthcare professionals, and to categorise them using the Theoretical Domains Framework (TDF).

Methods: A qualitative study was conducted at a combined university and regional hospital in the Netherlands between January 2019 and February 2020. Older adults (≥70 years) admitted to the Department of Internal Medicine with an acute medical illness were recruited using purposive sampling. For every patient, a healthcare professional (physiotherapist, nurse or physician) involved with this patient was also recruited. Semi-structured individual interviews were audiotaped, transcribed and analysed using directed qualitative content analysis. Barriers and enablers to physical activity during hospitalisation were identified and coded using the 14 domains of the TDF as an a-priori coding template. A descriptive summary of the reported barriers and enablers was composed for each TDF domain.

Results: Meaning saturation was reached after interviews with 12 patients and 16 healthcare professionals. A large number of barriers and enablers were identified and each categorised to 11 of the 14 domains of the TDF. Barriers and enablers were often reported as opposites, with the absence of a factor perceived as a barrier and its presence as an enabler. Although patients and healthcare professionals reported many similar factors, healthcare professionals reported a larger number of barriers and enablers as they perceive them from a broader perspective. The domain ‘Environmental Context and Resources’ in particular yielded many examples, and revealed that the hospital environment exerts an inactivating influence on patients. Our findings also suggest the importance of the domains ‘Knowledge’ and ‘Skills’ on patients’ physical activity behaviour.

Conclusions: This study has yielded an overview of barriers and enablers to physical activity behaviour in hospitalised older adults admitted to a hospital with an acute medical illness, and has categorised them using the TDF. The large number of barriers and enablers identified highlights the complexity of influencing older adults’ physical activity behaviour during hospitalisation. We therefore recommend that clinicians and researchers develop interventions targeted at multiple factors.

Implications: This overview of barriers and enablers to physical activity in older adults admitted to a hospital with an acute medical illness represents an initial step towards developing, evaluating and implementing theory-informed behaviour change interventions to improve hospitalised older adults’ physical activity behaviour. It can assist clinicians and researchers in selecting modifiable factors that can be targeted in future interventions.

Funding acknowledgements: This research received no funding.

Keywords:
Physical activity
Hospital
Older adults

Topics:
Health promotion & wellbeing/healthy ageing/physical activity
Older people
Disability & rehabilitation

Did this work require ethics approval? Yes

Institution: Maastricht University Medical Center

Committee: University Hospital Maastricht and Maastricht University (METC azM/UM)

Ethics number: METC2018-0718