Barriers and Facilitators to the Uptake and Maintenance of Healthy Behaviours by People at Mid-Life: A Rapid Systematic Review

Abstract

BackgroundWith an ageing population, there is an increasing societal impact of ill health in later life. People who adopt healthy behaviours are more likely to age successfully. To engage people in health promotion initiatives in mid-life, a good understanding is needed of why people do not undertake healthy behaviours or engage in unhealthy ones.MethodsSearches were conducted to identify systematic reviews and qualitative or longitudinal cohort studies that reported mid-life barriers and facilitators to healthy behaviours. Mid-life ranged from 40 to 64 years, but younger adults in disadvantaged or minority groups were also eligible to reflect potential earlier disease onset. Two reviewers independently conducted reference screening and study inclusion. Included studies were assessed for quality. Barriers and facilitators were identified and synthesised into broader themes to allow comparisons across behavioural risks.FindingsFrom 16,426 titles reviewed, 28 qualitative studies, 11 longitudinal cohort studies and 46 systematic reviews were included. Evidence was found relating to uptake and maintenance of physical activity, diet and eating behaviours, smoking, alcohol, eye care, and other health promoting behaviours and grouped into six themes: health and quality of life, sociocultural factors, the physical environment, access, psychological factors, evidence relating to health inequalities. Most of the available evidence was from developed countries. Barriers that recur across different health behaviours include lack of time (due to family, household and occupational responsibilities), access issues (to transport, facilities and resources), financial costs, entrenched attitudes and behaviours, restrictions in the physical environment, low socioeconomic status, lack of knowledge. Facilitators include a focus on enjoyment, health benefits including healthy ageing, social support, clear messages, and integration of behaviours into lifestyle. Specific issues relating to population and culture were identified relating to health inequalities.ConclusionsThe barriers and facilitators identified can inform the design of tailored interventions for people in mid-life.

Perceived Barriers to Maintaining Healthy Body Weight among Saudi Women of Reproductive Age in Jeddah City

“…The sum score of social environmental barriers subgroups to PA (lack of support, lack of time, social influence, and social norms barriers) showed that the lack of time engaged in PA was the most important subgroup barriers for PA social environmental barriers among the study population. These findings were in agreement with previous studies [52,57,59]. However, in our study, the other social environmental subgroups barriers that also had a considerable impact on the women's PA included the lack of support from family and friends and a lack of social influence and norms.…”

“…The sum score of the social environmental barriers subgroups to HE (lack of time, social influence, and lifestyle changes) showed that the lack of time to prepare and plan healthier meals (due to family commitments and social activities) was the most important social environmental barriers to HE among the study population. In previous studies, lack of time was one of the most frequently reported barriers in developed and developing countries [39,52,57,58]. In the current study, when the response categories very likely and somewhat likely were combined, the lack of time related to family and social commitment (reported by 39.5%) was more common than the lack of time due to job demands (34.1%) in the study population.…”

‘You started something … then I continued by myself’: a qualitative study of physical activity maintenance

“…Other participants spoke about lack of social support being a barrier to PA, explaining they were less likely to engage in PA if they did not have a companion. Kelly et al (2016) included studies that identified social support as a facilitator (Hooker et al, 2011;Babakus and Thompson, 2012) and those that identified lack of social support as a barrier (Im et al, 2013). Whilst we had too few participants from different ethnic groups to comment on important effects, cultural and ethnic differences can help to explain why some people place more importance on social support, in terms of PA, than others.…”

Retrospective cohort study of the South Tyneside Exercise Referral Scheme 2009–14: predictors of dropout and barriers to adherence

“…Tier 3 referrals) and those who consume alcohol, in terms of the effects that they have on ERS adherence. Previous studies regarding barriers to PA have either not focused specifically on ERS 13 or have only recorded barriers for participants that have dropped out 14 , making comparisons to this study difficult. Further investigation into why a lack of motivation or childcare predict adherence is required, as the findings appear counterintuitive At present there is no available research regarding secondary care referrals as they have been excluded from most studies and recent systematic reviews 3 15 .…”