Gendered perceptions of physical activity and diabetes in rural Bangladesh: a qualitative study to inform mHealth and community mobilization interventions

Abstract

Background Diabetes prevalence is increasing rapidly in Bangladesh, and there is an urgent need to promote preventive behaviours for type 2 diabetes, such as maintaining a healthy body weight, eating healthily, avoiding tobacco and being active for 150 minutes per week. Methods We used a qualitative methodology informed by the capability, opportunity, motivation theory of behaviour change to explore the factors affecting physical activity among men and women in rural Bangladesh. We conducted semi-structured interviews and focus group discussions with 64 purposively sampled participants with and without diabetes, and five health workers. From the results of descriptive content analysis, we identified key capabilities, opportunities and motivations to engage with in our mHealth and community mobilization interventions. Results Men and women without diabetes lacked awareness about the need to remain physically active to prevent diabetes, and most felt that their activity levels were sufficient. Housework was not commonly perceived as physical activity among all respondents. These knowledge and capability gaps could be addressed through mHealth messaging and community mobilization providing information on sufficiency and types of physical activity to prevent and control diabetes. Men were physically active while working outside the home, whereas women felt unsafe and conspicuous, and were constrained by family commitments and social expectations of appropriate behaviour. Women engaged in strategies to protect their own and their family's reputations. These opportunity factors affecting physical activity indicated the need for strategies developed through participatory processes to challenge unhealthy gender norms and increase women's safety. Conclusion Formative research data can enable the development of contextually relevant interventions. Data show that mHealth interventions should consider gendered barriers to physical activity, tailoring information to meet men's and women's needs, and that community mobilization interventions should enable unhealthy, gendered community norms to be challenged. Participatory interventions can enable communities to push the boundaries of socially acceptable behaviours to increase physical activity, helping to prevent and control diabetes.

Exploration of Physical Activity Barriers and Facilitators Among Adults in Kathmandu, Nepal

“…Although younger men seemed to support female household members, older men were reluctant. This finding is consistent with previous studies from Nepal (Kadariya & Aro, 2018; Oli et al, 2018), South Asia (Medagama & Galgomuwa, 2018; Morrison et al, 2019), Saudi Arabia (Al-Hazzaa, 2018), and migrant Indians (Ramanathan & Crocker, 2009), which have reported gender norms, cultural expectations, and family responsibilities limited women’s PA participation. The patriarchal setting in many South Asian communities seldom allocates decision-making power to women (Herath, 2015).…”

“…A Sri Lankan study (Medagama & Galgomuwa, 2018) has also reported that puddles, uneven roads and pavements, and being chased by unrestrained animals (e.g., stray dogs) limited PA participation. Another study from Bangladesh has reported that women feared falling over on muddy roads and uneven paths and the resultant embarrassment, which in turn discouraged PA participation (Morrison et al, 2019). This further reinforces the need for multisectoral collaboration in ensuring PA-friendly built environment.…”

Participatory learning and action to address type 2 diabetes in rural Bangladesh: a qualitative process evaluation

“…Our formative research showed that before the intervention, women often felt unable to walk for exercise because they were not allowed by their husbands, they were too embarrassed, they felt unsafe, or they were afraid of social criticism [21]. Men and women were also afraid that people would think they had diabetes if they walked.…”

“…Moreover, in Bangladesh, purdah (female seclusion), restricts women’s freedom of movement and their access to public spaces. Women are expected to behave demurely, avoid attracting attention from men, and uphold family honour [21]. Norms about the division of labour within and outside the household, as well as norms about movement outside the household are highly gendered [22].…”

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

“…(Iran) [60] "Women reported that it was considered inappropriate for them to walk on muddy roads and that they were afraid of slipping." (Bangladesh) [41]…”