Developing a complex understanding of physical activity in cardiometabolic disease from low-to-middle-income countries—a qualitative systematic review with meta-synthesis

Martin Heine*, Marelise Badenhorst, Chanel van Zyl, Gabriela Lima de Melo Ghisi, Abraham Samuel Babu, John Buckley, Pamela Serón, Karam Turk-Adawi, Wayne Derman

*Corresponding author for this work

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Physical activity behaviour is complex, particularly in low-resource settings, while existing behavioural models of physical activity behaviour are often linear and deterministic. The objective of this review was to (i) synthesise the wide scope of factors that affect physical activity and thereby (ii) underpin the complexity of physical activity in low-resource settings through a qualitative meta-synthesis of studies conducted among patients with cardiometabolic disease living in low-to-middle income countries (LMIC). A total of 41 studies were included from 1200 unique citations (up to 15 March 2021). Using a hybrid form of content analysis, unique factors (n = 208) that inform physical activity were identified, and, through qualitative meta-synthesis, these codes were aggregated into categories (n = 61) and synthesised findings (n = 26). An additional five findings were added through deliberation within the review team. Collectively, the 31 synthesised findings highlight the complexity of physical activity behaviour, and the connectedness between person, social context, healthcare system, and built and natural environment. Existing behavioural and ecological models are inadequate in fully understanding physical activity participation in patients with cardiometabolic disease living in LMIC. Future research, building on complexity science and systems thinking, is needed to identify key mechanisms of action applicable to the local context.
Original languageEnglish
Article number11977
JournalInternational Journal of Environmental Research and Public Health
Issue number22
Publication statusPublished - 1 Nov 2021

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