Innovative participatory evaluation methodologies to assess and sustain multilevel impacts of two community-based physical activity programs for women in Colombia

Abstract

Background Community-based physical activity (PA) programs are appealing to women in Latin America and show potential for improving women’s health. This study aimed to engage healthy middle-aged women, breast cancer survivors and local stakeholders participating in two publicly funded community-based PA programs in Bogotá, Colombia (Recreovía and My Body) to assess and visually map the perceived barriers, facilitators, and outcomes to promote programs’ improvement, scaling and sustainability. Methods We used two participatory action research methods, the 1) Our Voice citizen science method to capture data and drive local change in built and social environmental facilitators and barriers that influence women’s engagement in community-based PA; and 2) Ripple Effects Mapping to visually map the intended and unintended outcomes of PA programs. We used thematic analysis to classify the results at the individual, social, and community levels. Results The stakeholders engaged in the participatory evaluation included cross-sector actors from the programs (N = 6) and program users (total N = 34) from the two programs (Recreovía N = 16; My Body N = 18). Program users were women with a mean age of 55.7 years (SD = 8.03), 65% lived in low-income neighborhoods. They identified infrastructure as the main feature affecting PA, having both positive (e.g., appropriate facilities) and negative (e.g., poorly built areas for PA) effects. Regarding program improvements, stakeholders advocated for parks’ cleaning, safety, and appropriate use. The most highlighted outcomes were the expansion and strengthening of social bonds and the engagement in collective wellbeing, which leveraged some participants’ leadership skills for PA promotion strategies in their community. The facilitated dialogue among program users and stakeholders fostered the sustainability and expansion of the community-based PA programs, even during the COVID-19 pandemic. Conclusions The implementation of both participatory methodologies provided a multidimensional understanding of the programs’ impacts and multisectoral dialogues that fostered efforts to sustain the community-based PA programs.

Narrative review – Barriers and facilitators to promotion of physical activity in primary care

“…highlighted competing demands between leisure‐time activities and PA. Issues such as socialising were identified as preventing time for PA, but many of these barriers are not mutually exclusive. Repeatedly the literature cites a lack of support for PA as a barrier, whilst having supporting family and friends is seen as one of the biggest enablers of PA 13,18,22,30,42,68,69,71,72,74,75,77,78,81,85–87,89,93–95 . Creating a culture of PA, addressing leisure‐time, commuting and occupational (where possible) PA could have a hugely beneficial effect at removing barriers to PA uptake.…”

“…The majority of the studies identified were from Anglo‐European Western cultures, with only four from other parts of the world: Colombia, Saudi Arabia, Thailand and Oman 30,78,94,95 . These studies highlighted some socio‐cultural issues influencing PA for health, with reference to cultural norms for females within Arabic cultures 78,94 .…”

“…As with healthcare professionals, patients also highlighted a lack of facilities preventing the uptake of PA 26,30,42,73,75,76,80,81,89,93–95,98 . In a review of PA in osteoarthritis, Stevenson and Roach 75 identified an ‘Exercise Milieu’ questionnaire subscale, which found that a lack of locations, and greater distance from exercising locations were barriers to uptake.…”

“…Repeatedly the literature cites a lack of support for PA as a barrier, whilst having supporting family and friends is seen as one of the biggest enablers of PA. 13,18,22,30,42,68,69,71,72,74,75,77,78,81,[85][86][87]89,[93][94][95] Creating a culture of PA, addressing leisure-time, commuting and occupational (where possible) PA could have a hugely beneficial effect at removing barriers to PA uptake. Parkrun (a community-based running initiative)…”

“My Body, My Rhythm, My Voice”: a community dance pilot intervention engaging breast cancer survivors in physical activity in a middle-income country

“…Among Colombian BCS, low physical activity levels have also been reported [ 14 ]; however, to the best of our knowledge, there are no prevalence estimates of physical activity among BCS in Colombia. We know that 57% of Colombian adult women do not meet the current guidelines [ 15 ], and the most reported barriers to regular physical activity for Colombian women include time management, caregiving roles, safety concerns, and inadequate recreational facilities [ 16 , 17 ].…”