Developing a Complex Understanding of Physical Activity in Cardiometabolic Disease from Low-to-Middle-Income Countries—A Qualitative Systematic Review with Meta-Synthesis

Abstract

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.

General Public’s knowledge, awareness, and perception of Cardiometabolic diseases: data from a Singapore study population

“…While the current literature has explored the perception of cardiometabolic disease in the Western population ( 24 ), there is limited data on the knowledge and perception of cardiometabolic diseases within the Singaporean population ( 25 , 26 ). Given the unique cultural and socio-economic factors that influence risk perception and actions ( 27 ), this study aims to provide insights into the perception of cardiometabolic diseases the Singapore population by exploring the general public’s attitudes and knowledge of the disease, self-perceived risks and actions taken to improve metabolic health, stratified by the presence of metabolic risk factors (MFs). These unique perspectives can help inform policy makers on the vital components of cardiometabolic diseases that needs to be addressed, as well as the identification of vulnerable population subgroups that may benefit from targeted interventions.…”

Knowledge on hypertension in Myanmar: levels and groups at risk

“…the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions, determines how well people are able to translate knowledge into appropriate (health-) behaviour 10 , 11 . According to the socioecological model, health behaviour is also determined by the social, physical and policy environment in which it occurs 12 , 13 . Socio-demographic factors influence the knowledge of diseases and risk factors, therefore behaviour 14 – 17 .…”

“…It is not clear why specifically this theory was adopted for understanding prevention and control of HTN in Myanmar; specifically, as this theory largely “excludes” eccentric/environmental factors that inform behavior. For example, we have shown that for physical activity, a more holistic approach would be needed to fully grasp PA behavior when settings with limited resources are concerned (Heine et al , 2021 1 ). A framework of behaviour that is more response to contextual factors, may also aid the introduction (and selection) of the variables of interest you specifically looked at (e.g., socio-economic status).…”