Equity-specific effects of interventions to promote physical activity among middle-aged and older adults: results from applying a novel equity-specific re-analysis strategy

Abstract

Background Reducing inequalities in physical activity (PA) and PA-associated health outcomes is a priority for public health. Interventions to promote PA may reduce inequalities, but may also unintentionally increase them. Thus, there is a need to analyze equity-specific intervention effects. However, the potential for analyzing equity-specific effects of PA interventions has not yet been sufficiently exploited. The aim of this study was to set out a novel equity-specific re-analysis strategy tried out in an international interdisciplinary collaboration. Methods The re-analysis strategy comprised harmonizing choice and definition of outcomes, exposures, socio-demographic indicators, and statistical analysis strategies across studies, as well as synthesizing results. It was applied in a collaboration of a convenience sample of eight European PA intervention studies in adults aged ≥45 years. Weekly minutes of moderate-to-vigorous PA was harmonized as outcome. Any versus no intervention was harmonized as exposure. Gender, education, income, area deprivation, and marital status were harmonized as socio-demographic indicators. Interactions between the intervention and socio-demographic indicators on moderate-to-vigorous PA were analyzed using multivariable linear regression and random-effects meta-analysis. Results The collaborative experience shows that the novel re-analysis strategy can be applied to investigate equity-specific effects of existing PA interventions. Across our convenience sample of studies, no consistent pattern of equity-specific intervention effects was found. Pooled estimates suggested that intervention effects did not differ by gender, education, income, area deprivation, and marital status. Conclusions To exploit the potential for equity-specific effect analysis, we encourage future studies to apply the strategy to representative samples of existing study data. Ensuring sufficient representation of ‘hard to reach’ groups such as the most disadvantaged in study samples is of particular importance. This will help to extend the limited evidence required for the design and prioritization of future interventions that are most likely to reduce health inequalities.

Health behavior interventions among people with lower socio-economic position: a scoping review of behavior change techniques and effectiveness

“…This can be achieved by empirical studies that are powered for detecting moderation effects or by re-analyzing representative samples of existing intervention data (e.g. Czwikla et al, 2021 ). Building further on such insights, future research could examine whether interventions and their BCTs affect the hypothesized MoAs in similar ways among lower and higher SEP groups (Michie et al, 2009 ).…”

Trajectories of CVD medication after statutory retirement: contributions of pre-retirement sociodemographic, work and health-related factors: a register study in Finland

“…Identifying distinct developments could also help better target policy interventions, as it is likely that all groups do not need similar interventions, and some groups may not even need them at all. Furthermore, it is important to pay special attention to those groups that are more disadvantaged and often the hardest to reach [ 28 ].…”

Soziale Ungleichheit im Zusammenhang mit digitalen Gesundheitsanwendungen: Digitale Spaltungen in den Bereichen Zugang, Nutzung, Wirksamkeit und Privatsphäre

“…In den 13 einbezogenen Studien fanden die Autor*innen nur in einer Studie Informationen zu möglichen Ungleichheiten im Zugang und wenig konsistente Ergebnisse zu den Bereichen Nutzung und Wirksamkeit, sodass eine Abschätzung zum Impact des Zusammenwirkens der 3 Bereiche nicht möglich ist. Andere Übersichtsarbeiten zu diesem Thema berichteten ebenfalls über gemischte oder nicht schlüssige Ergebnisse, die den Mangel an verfügbaren Daten zu Ungleichheitsbereichen und deren bisweilen komplexe Interpretation verdeutlichen [ 35 , 36 ].…”