Perceived environmental, social, and policy influences on physical activity in rural Midwestern adults

Rural adults engage in less physical activity and are less likely to meet activity recommendations than urban or suburban adults. Understanding determinants of this behavior can help design interventions for increasing activity levels. This series of studies examined the perceived determinants of physical activity in the social, physical, and policy environments of rural adults, using the following aims:

Aim 1: A secondary analysis was conducted of a cross-sectional survey among 407 adults from two rural towns to examine determinants of physical activity separately by the domain in which this behavior occurs (i.e. home care, active living, etc.). Multiple regression analyses found that social characteristics (such as support from friends), policy attitudes (such as workplace incentives for exercise), and physical environmental factors (such as an activity-friendly neighborhood) were positively associated with total physical activity, active living, and sport. Barriers were negatively associated with these domains. No factors were associated with physical activity in work or home care. Physical activity determinants are specific to the domain of physical activity, and more research needs to be done to determine factors associated with physical activity in home or work.

Aim 2: Measurement tools should be culturally relevant to a specific population for accurate measurement. Three focus groups were conducted (n=19) in a rural Midwestern county to tailor existing measurement tools to this population. Focus group members were asked about the activities they engaged in and facilitators and barriers to those activities. Important factors associated with physical activity include social support and modeling active behavior. Focus group members desired to see community buildings be open to the public for exercise. This study revealed contextual issues and cultural language for tailoring physical activity measurement tools for rural adults.

Aim 3: Ecological models propose that the environment impacts behavior on several different levels. Using a tailored survey instrument, this study examined social, environmental, and policy-level determinants of physical activity at different levels of an ecological approach. A cross-sectional survey was given to 143 individuals residing in a rural Midwestern county. Test-retest reliability was examined using correlations and kappa statistics, and was found to be very good to substantial. Multiple regression analyses were conducted using general linear modeling. Social factors were associated with total physical activity; environmental factors were associated with active transport, house and yard work, vigorous activity, and walking; and policy factors were associated with physical activity at work, and moderate-intensity activity. Findings can be used to tailor physical activity interventions using an ecological approach in rural adults, based on the specific domain and intensity in which the activity occurs.

These studies provide insight into the contextual factors that are associated with physical activity in rural Midwestern adults, and provide evidence that determinants should be examined and presented by the domain and intensity in which this behavior occurs. It is clear that social and physical environments and policy attitudes are associated with domain- and intensity-specific physical activity in this population.