Experiences related to making healthy physical activity lifestyle choices during the COVID-19 pandemic: a qualitative study in a Teesside-based adult BAME population

Abstract

Studies indicated that prior to the COVID-19 pandemic, the majority of adult Black, Asian and Minority Ethnic (BAME) individuals lived a sedentary lifestyle, which exacerbated their physical inactivity behaviours during the COVID-19 subsequent lockdowns. Experiences related to making healthy physical activity (PA) lifestyle choices in adult BAME individuals during the COVID-19 pandemic were mapped onto the capability, opportunity, and motivation model of behaviour (COM-B model). Twelve adult BAME participants were interviewed using one-on-one, semi-structured interviews that lasted 45–60 min, which captured participant perceptions of PA engagement during the pandemic between April and August 2022 via Microsoft Teams. Using thematic analysis, three themes were generated and successfully mapped onto the modified COM-B model. These include the influence of culture on the PA lifestyle, the capability to engage in the PA lifestyle, and the self-reflective determination model. Although existing literature has used both the COM-B and the self-determination models, these have been generalised findings that are not representative of adult BAME individuals’ lived PA participation experiences. This enabled the modification of the COM-B and self-reflective determination models to reflect the experiences of adult BAME individuals with respect to PA participation as well as improving PA culturally related policies.

Keywords:

• Physical activity
• BAME
• COVID-19 pandemic
• adults
• COM-B model

Reviewing Editor:

• Joe Thomas, Institute of Health and Management, Australia

SUBJECTS:

• Physical Activity and Health
• Global Health

Introduction

Physical activity (PA) is any bodily movement produced by skeletal muscles that requires energy expenditure (World Health Organization, 2022). PA comprises exercise as well as other activities that involve bodily movement and are done as part of working, playing, active transportation, domestic chores, and leisure activities (World Health Organisation [WHO], 2022). The WHO declared COVID-19 a pandemic on 11 March 2020, affecting individuals worldwide (Cucinotta & Vanelli, 2020). As of 9 March 2021, mobility trends during the COVID-19 pandemic decreased in most locations, including retail and recreation, transit stations, grocery stores and pharmacies, and workplaces, but increased in parks and residential places (Venkatesh et al., 2022). During the epidemic, individuals spent more time at home and were not allowed to go out to parks and open areas, including public gardens, and dog parks, because of the high COVID-19 infection and death rates (Pan et al., 2021). With its numerous well-documented physical, social, and mental health advantages for individuals of all ages, particularly those with or at risk of chronic conditions, outdoor PA participation has great potential as a coping and preventative strategy (Li et al., 2023). According to Ige-Elegbede et al. (2019), Mbabazi, MacGregor, Breckon, Nalweyiso, et al. (2023) and Ajayi Sotubo (2021), BAME population refers to ethnic minority groups in the UK which includes individuals of black Afro-Caribbean background and Asian such as Bangladeshi, Indian and Pakistani. Studies show that PA helps prevent chronic illnesses, including cardiovascular disease, diabetes, and obesity; enhance cognitive performance and conditions; increase mental health and minimise falls or fall-related injuries (Langhammer et al., 2018; Pedersen & Saltin, 2015; Warburton et al., 2006). Nevertheless, very little PA benefit was attained during COVID-19, as most adult BAME individuals living with sedentary-related diseases died during the pandemic (Hall et al., 2021; Mbabazi, MacGregor, et al., 2022; Mbabazi, Kanmodi, et al., 2022).

Roth et al. (2020) led the research on the Global Burden of Disease (GBD). Those aged 25 and over who live a sedentary lifestyle have a risk factor that is responsible for 1.3 million deaths globally (17 deaths per 100,000 inhabitants). These findings, together with a number of systematic reviews that identified physical inactivity as a pandemic (Silva et al., 2020), supported the publication of the World Health Organisation Global Plan of Action for PA 2018–2030. This research demonstrated a relative decrease in sedentary behaviour of 10% by 2025 and of 15% by 2030.

The UK government policy document (GOV.UK, 2022) Office for Health Improvement and disparities of PA applying all our Health, published on 10th March 2022, estimated that physical inactivity costs the UK £7.4 billion per year (including £0.9 billion for the National Health Service alone). Physical inactivity is associated with one out of every six deaths that occur in the country (GOV.UK, 2022). Unfortunately, compared to the 1960s, the UK population is around 20% less active today. It is suggested that there will be a 35% decrease in PA by the year 2030 (GOV.UK, 2022). Men are more likely to indicate that they achieve the amount of PA that is advised for them than women (Craft et al., 2014). PA changes with age, and different ages and stages of life call for different amounts of PA (GOV.UK, 2022).

The disproportionate impact of the global COVID-19 pandemic on people from BAME backgrounds has highlighted the need to study BAME populations in a more in-depth manner. Out of the 13% of the UK adult population, 35% of those who were admitted to intensive care units in hospitals during COVID-19 in England were from BAME populations during the first wave of the COVID-19 pandemic (Pan et al., 2021). BAME populations experienced a higher risk of getting a COVID-19 infection (Pan et al., 2021), poorer clinical outcomes (Coleman et al., 2021), and higher mortality rates (Batty et al., 2021) compared to the white population. Additionally, mortality rates for black people were five times higher and twice as high for South Asians when compared to Caucasians (Batty et al., 2021). Researchers agree that the COVID-19 pandemic has been both disruptive of several health-related behaviours and negatively impacted mental health (Burton et al., 2021; Giuntella et al., 2021; Sanders et al., 2021).

To help in understanding the specific factors relating to disadvantaged BAME adults and PA, the COM-B model was applied within this study. The COM-B model is a tool for analysing behaviour that can be applied to individuals, subgroups, populations, and organisations (Michie et al., 2011). The COM-B Model was propounded by Susan Michie, Maartje van Stralen, and Robert West in 2011 (Michie et al., 2011). The COM-B model proposes that there are three components to any behaviour (B): Capability (C), Opportunity (O), and Motivation (M) (Michie et al., 2011). The reflective element of the COM-B model involves self-consciousness and planning, while the automatic element involves wants, needs, and desires (Liu et al., 2018). On the other hand, the self-determination theory (SDT) is an existing theory that provides a broad framework for the study of human motivation and personality, although individuals often say that self-determination is not about control (Guay, 2022; Mbabazi, MacGregor, Breckon, Tolchard, et al., 2023).

Rationale and significance of the study

Reversing this trend of low PA engagement among adult BAME groups is a main factor in the UK government’s commitment to tackling the health inequities that exist within the UK. There is an established correlation between socio-economic deprivation and low PA participation (GOV.UK, 2022), particularly in individuals of African, Asian, and Middle Eastern descent within the UK. These individuals have been found to carry a considerably heavier burden of illness than people of other ethnic backgrounds (Ige-Elegbede et al., 2019; Ige-Elegbede et al., 2019; Mbabazi, MacGregor, Breckon, Tolchard, et al., 2023). There is a paucity of studies that have mapped specific adult BAME perceptions and experiences of PA participation in the UK onto the COM-B model domains. Therefore, this study emerges from the belief that the perceptions of BAME individuals on the barriers and facilitators of PA participation among adult Teesside-Based BAME Individuals’ have changed markedly due to the COVID-19 pandemic.

Aim

The aim of the study is to evaluate experiences related to making healthy PA lifestyle choices during the COVID-19 pandemic in the North-East of England among the adult BAME population.

Methods

This qualitative research was conducted at Teesside University in the Northeast of England, located in Middlesbrough and the Tees Valley, an area of low socio-economic status (The Trussell Trust, 2023). This study used a hermeneutic phenomenology design because it brought to light and reflected upon deep-lived participants’ experiences (Neubauer et al., 2019). Researchers use this design to progress from a human phenomenon, such as grief, and determine themes inherent to this phenomenon (Neubauer et al., 2019). When this combined with an inductive analysis of the collected data, it became possible to look at the challenges individuals faced and how they dealt with PA participation based on their own experiences (Neubauer et al., 2019). The Teesside University Health Research Ethics Sub-committee approved this study (2022 Mar 7747 MBABAZI).

Sampling and recruitment

Participants from the adult BAME population were more suitable to participate in the study because they had the characteristics the researcher needed to investigate. Hence, researchers used purposive sampling technique to recruit twelve adult BAME participants from Teesside University. However, it can be argued that this sampling technique may not be an accurate representation of the whole UK adult BAME population. To limit corona virus transmission, interviews had to be conducted using Microsoft Teams. A gatekeeper was appointed to post a study invitation and recruitment information on the university’s Virtual Learning Environment site, ‘Blackboard’, inviting individuals interested in taking part in the study. Participants that met the criteria were those of BAME origin, highly educated students residing within the Teesside region, adults (18 years or over) and conversant in the English language. Participants were recruited via an online learning platform to participate in the research study. Potential participants contacted the researcher and were invited via email to complete the participant information sheet with demographic data. Data was obtained, transcribed, and stored on a password-protected North-East of England University server (Dell’Amico et al., 2010; Da Silva, 2021).

Interviews

Data was collected using semi-structured interviews. Each interview lasted between 45 and 60 min and was conducted via Microsoft Teams to limit coronavirus transmission (Shrestha et al., 2020). Online interviews have been used successfully in health research, and these were conducted using Microsoft TEAMS, which allowed for audio recording as well as transcription (Lieux et al., 2021). The researcher conducted all interviews in a quiet room at the University of North-East England campus. This implies that no one outside could overhear the participant’s submissions or the researcher’s questions. The researcher conducted the interview based on the interview guide in the study (Peters & Halcomb, 2015). During this process, the researcher to allowed cross-referencing with the transcription provided. This enabled the researcher to reflect on the participants’ experiences, increasing the trustworthiness and validity of the interview process (Moser & Korstjens, 2022). All participants were given the option to review their transcripts for reliability and validity, with six taking up this offer with no modifications requested.

The views of the adult BAME individuals in relation to their experiences of living a PA lifestyle during the coronavirus pandemic varied. As a pilot study, the interview schedule was made for three of the 15 people and 12 of those were interviewed after obtaining verbal consent (JM). In addition, there were 12 interviews for which no new information was obtained from participants (Ando et al., 2014; Moser & Korstjens, 2022). It was more effective to thoroughly analysed the data manually (JM and FM), which means analysing text and tagging specific parts of the feedback with themes. To capture participants’ in-depth lived experiences as adult BAME individuals in relation to PA, data was gathered using a qualitative method that involved one-to-one interaction via semi-structured interviews. The primary researcher read the transcripts several times to fully understand the information. It was advantageous to systematically annotate the transcripts, conceptualise the data, segment the data, analyse the data, and write up the results. Twelve participants were a sufficient sample size because no new information was being garnered in the transcripts (Ando et al., 2014; Moser & Korstjens, 2022), and no new themes emerged. This meant the data was enough to answer the research question. The average length of the interview was 45–60 min, and the mean length was 52 min. The data collection ended with the collection of 12 interviews.

Data analysis

An inductive approach was used during data analysis to allow the researcher to broaden the analytic field of vision by first familiarising himself with the dataset (Nowell et al., 2017). On A3 paper, questions for the interview schedule were written. The data were analysed for semantic or latent codes, subthemes, and themes for each interview question answered by each participant by looking at every participant’s submission response in the interview transcripts. Tables were drawn with headings for semantic or latent codes, subthemes, and themes (Braun & Clarke, 2022). The data was analysed manually using A3 paper (JM and FM). Analysing the data manually allowed the researcher to be attentive to participants’ language, nonverbal communication, and pauses (Byrne, 2022). Sutton and Austin (2015) argue that the researcher should investigate alternative interpretations and place emphasis on his subjectivity. All interviews were audio-recorded in English and transcribed verbatim.

The study considered perceptions of PA, awareness of the health benefits of PA, pre-contemplation and contemplation of performing PA, reasons for giving up on PA, drawing on the COM-B model, facilitators and barriers to PA, and the roles of ethnicity and culture in forming PA lifestyle choices (Morgan et al., 2016; Ige-Elegbede et al., 2019).

Results

Twelve first-generation BAME adults living in the University of Northeast England area were recruited from the student population, and their demographic breakdown is demonstrated in Table 1. Table 2 also demonstrates the ethnic breakdown of participants by gender. To ensure the participants confidentiality, they were each assigned a unique reference number numbered from participant 1–12 in the study.

Table 1. Social-demographic characteristics of participants.

Demographics		No. of participants
Age	28–35	6
	36–45	5
	46–55	1
Identified Gender	Male	6
	Female	6
Ethnicity	Black / Black British - African	9
	Asian / Asian British - Indian	3

Table 2. Ethnicity breakdown by gender.

Ethnicity	Identified gender	No. of participants
Black/Black British – African	Male	5
	Female	4
Asian/Asian British – Indian	Male	1
	Female	2

On an A3 sheet of paper, questions for the interview schedule were in line with the research objectives (Braun & Clarke, 2022). The data for the analyses of semantic or latent codes, subthemes, and themes were generated from each interview schedule question answered by each participant, looking at every participant’s response in the interview transcripts (Braun & Clarke, 2022). The data was analysed using thematic reflexive analysis (TA) and the six-stage protocol recommended (Denham & Onwuegbuzie, 2013; Braun & Clarke, 2022; Byrne, 2022).

Summary of the main findings

Twelve participants (six males and six females) are of the first generation. Three overarching themes were identified through TA of the collated data: the influence of culture on the PA lifestyle, the capability to engage in the PA lifestyle, and the self-reflective determination model. The themes were visually mapped onto the COM-B model dimensions (Figure 1). To further explain the results, direct quotes were obtained from the interviews as demonstrated in Table 3.

Figure 1. Summary of mapping of themes onto the COM-B model (Adapted from Roche et al., 2022).

Table 3. Summary of process of thematic analysis and themes identified.

Supporting quotes	Codes	Subthemes	Key theme
‘……….in my culture, for example, a woman doesn’t have to work as she is happy being a housewife back home, although there is currently a shift when women live in the UK, and the majority of Asian women prefer to depend on their husbands for more or less everything and to provide for a home’ (P1). ‘…. also, in Africa, where I am from, men do all the heavy lifting, including splitting firewood." Men are happy to demonstrate that they are hardworking and stronger than their women. That women find it attractive’ (P10).	Women depend on man everything. Men heavy lifting for example most jobs that include PA like heavy lifting is a man’s job. For example, splitting firewood	Gender roles	The Influence of culture on the PA lifestyle
‘……my culture will not permit that. If you wear your Muslim attire, which covers your knees and head, religion takes precedence over PA, depending on its role in my culture. Like in Asian culture, it is compulsory for women to cover their heads with a hijab or wear skirts, while males must wear turbans’ (P2). ‘…….in our culture, women shouldn’t wear revealing short skirts or dresses in and out of the house and must seek permission to go out to perform any physical activities’ (P5).	Clothes wear swimming costumes exposes body. sportswear exposes body, cycling clothes exposes women body. Women wake up early to do domestic work like cleaning the compound, utensils, washing clothes and cooking is also a good form of PA lifestyle.	Cultural practices and religion
‘……in the UK, you have to be skinny to be attractive to a man. They work so hard with the PA lifestyle. That’s the outlook here. But like back home, you have to be fat to look beautiful and attractive as a woman. In my culture, that is how it is’ (P7). ‘……I believe that in most cultures, women prefer to be slim, but this was not always the case, and in some cultures, being fat is preferred. I mean, having more weight in some cultures is very good. I have seen some Arabian or African cultures, but in the majority of the other cultures, including mine, women want to be big. This affects PA’s lifestyle’ (P2). ‘……even more so when I get these compliments when my husband is there. It makes me happy. As an African woman, I feel it is also my duty or obligation to look beautiful for my man’ (P4).	Fat is beautiful and attractive. Shift in cultural perceptions of body image construct. Shift in body image perceptions. For example, in most cultures, women desire to be slim, while in others, being overweight is preferred. Some cultures value having extra weight. As an African woman I feel it is also my duty or obligation to look beautiful for my man. I am between beliefs big women are beautiful. Even fat ladies dancing attracts African males.	Cultural perception of body image
‘……. I am limited due to injuries, pains in joints and fatigue. But for performing severe PA is so difficult’ (P2) ‘…….in recent times, no. I am not able to live an active PA lifestyle. Well, primarily this is because I have this pain in my knee whenever I do a small sprint, like if I had to run on this’ (P6). ‘…. I am asthmatic during PA. I often breathe more quickly through my mouth. I have my inhalers in case I experience muscle tightening of the lungs. It is rare but there is a chance of experiencing an asthma flare up. Being asthmatic somehow limits me.’ (P10).	Knee pain Ankle pain Pregnancy Injuries Age Asthama	Physical barriers	The capability to engage in the PA lifestyle
‘……. also, restrictions, as I have self-awareness of COVID-19 is transmissible and I don’t want to get infected. All these changes limit me, despite the fact that I am still a young Asian man’ (P2). ‘……also fear from getting infected with COVIID-19 will cause a lot of social, psychological, and biological setbacks. So, I still think these limits me’ (P5).	Stress Fear Worry Anxiety Depression	Psychological barriers
‘PA enjoys walking and jogging, which I do as well. I am still self-motivated to do physical activities for my inner self, as I feel like I am growing every day and also enjoy PA, to be honest. I don’t need anyone to motivate me; I grow all the time and am fulfilled. I also do PA to reduce stress and depression’ (P8). ‘…. I also like walking and running for my mental health. I enjoy doing extra exercises as part of my PA to support my community, such as running for charity events such as cancer charity events’ (P12).	Jogging Step counting Voluntary running for charity Self-motivation Self-reflection and desirable ambition for body image.	Participants’ maintenance of PA levels is down to inner motivation	Self-reflective determination theory
‘……I had a chance to reflect on my personal PA lifestyle and see how I can personally motivate myself’ (P3). Another participant stated: ‘…. every day in COVID-19 lockdown provided a chance to personally reflect on my PA and new opportunity to move and exercise, which improved mood, sleep, and physical health in the short and long term’ (P5).	I reflected to understand what worked for me during PA during COVID 19 lockdown/ I had a chance to reflect on my personal PA lifestyle. I reflected on the new opportunities of PA. I reflected on the importance of PA lifestyle. I started reflecting on my own health and why it is important to engage in PA. I reflected and became conscious of PA levels. I reflected and was more aware on the benefits of PA lifestyle	Participant attitudes / behaviours reflection on the importance of PA lifestyle

Theme 1: the influence of culture on PA lifestyle

The experiences and views of several participants were categorised into three subthemes: gender roles, cultural practices and religion, cultural beliefs and attitudes, and cultural perceptions of the body.

Subtheme 1: gender roles

BAME gender roles are shaped by family, environment, and society. Minority ethnic groups’ responsibilities are highly gendered. Women in BAME culture are expected to be housewives, become pregnant, and raise children. One participant stated:

……….in my culture, for example, a woman doesn’t have to work as she is happy being a housewife back home, although there is currently a shift when women live in the UK, and the majority of Asian women prefer to depend on their husbands for more or less everything and to provide for a home. (P1)

The following examples of gender stereotyping have a masculine cultural effect, even now in BAME communities where males are still seen as stronger, for example while carrying heavy baggage or splitting wood. Men desire to be stronger than women in ethnic minority groups. For example:

…. also, in Africa, where I am from, men do all the heavy lifting, including splitting firewood. Men are happy to demonstrate that they are hardworking and stronger than their women. That women find it attractive. (P10)

Subtheme 2: cultural practices and religion

PA schedules, programmes, and engagement are limited in several ethnic minority cultures due to religious commitments. In participant interviews, swimming costumes, sportswear, and cycling clothes exposed the body. Women get up early to clean the house and wash dishes. Participant 2 noted:

……my culture will not permit that. If you wear your Muslim attire, which covers your knees and head, religion takes precedence over PA, depending on its role in my culture. Like in Asian culture, it is compulsory for women to cover their heads with a hijab or wear skirts, while males must wear turbans. (P2)

Men and women are expected to dress in typical cultural attire. For instance, a participant stated:

…….in our culture, women shouldn’t wear revealing short skirts or dresses in and out of the house and must seek permission to go out to perform any physical activities. (P5)

Subtheme 3: cultural perception of body image

The dataset reveals cultural differences in body image perceptions, such as that ‘fat is beautiful and attractive’ in the African country of origin. For example, Participant 7 stated:

……in the UK, you have to be skinny to be attractive to a man. They work so hard with the PA lifestyle. That’s the outlook here. But like back home, you have to be fat to look beautiful and attractive as a woman. In my culture, that is how it is. (P7)

Culture affects body image and body size perceptions from an early age, and in many BAME groups, being overweight has been associated with richness, health, strength, and fertility. For example, participant 2 stated:

……I believe that in most cultures, women prefer to be slim, but this was not always the case, and in some cultures, being fat is preferred. I mean, having more weight in some cultures is very good. I have seen some Arabian or African cultures, but in the majority of the other cultures, including mine, women want to be big. This affects PA’s lifestyle. (P2)

In addition, another participant performs PA to attain an ideal body image for herself and for the husband. She remarked:

……even more so when I get these compliments when my husband is there. It makes me happy. As an African woman, I feel it is also my duty or obligation to look beautiful for my man. (P4)

Theme 2: capability to engage in PA lifestyle

Participants felt that there were physical and psychological barriers. Two subthemes were generated: physical and psychological barriers.

Subtheme 1: physical barriers

Participants revelled those injuries from football, running that resulted in joint pains and knee pains limited their PA lifestyle. For example, a participant said:

……. I am limited due to injuries, pains in joints and fatigue. But for performing severe PA is so difficult (P2)

Participants’ abilities to live a PA lifestyle were severely limited due to joint injuries, knee pain, and ankle pain. For instance, a participant said:

…….in recent times, no. I am not able to live an active PA lifestyle. Well, primarily this is because I have this pain in my knee whenever I do a small sprint, like if I had to run on this. (P6)

Another participant echoed a similar view. For example, participant 7 stated:

…. I’m not fit because I am overweight have seen myself go like up many stairs and by the time, I get to the third floor in the library. I’m out of breath. Being overweight has led to my knee and ankle pains. I get breathless moving upstairs in the library. (P7)

Subtheme 2: psychological barriers

Some participants’ interview data also highlighted the psychological barriers for example, stress, fear, and worry that limited their PA lifestyle. For instance, a participant said:

……. also, restrictions, as I have self-awareness of COVID-19 is transmissible and I don’t want to get infected. All these changes limit me, despite the fact that I am still a young Asian man. (P2)

For example, another participant noted:

……also fear from getting infected with COVIID-19 will cause a lot of social, psychological, and biological setbacks. So, I still think these limits me. (P5)

Theme 3: self-reflective determination theory during COVID-19

The interview data set revealed participants’ strengths and weaknesses can be found not only in their ability or inability to live a PA lifestyle as highlighted in the subthemes.

Subtheme 1: Participants maintenance of PA levels is down to inner motivation.

A participant demonstrated self-motivation, growth, fulfilment, and enjoyment as key reasons for living a PA lifestyle: A participant noted:

PA enjoys walking and jogging, which I do as well. I am still self-motivated to do physical activities for my inner self, as I feel like I am growing every day and also enjoy PA, to be honest. I don’t need anyone to motivate me; I grow all the time and am fulfilled. I also do PA to reduce stress and depression. (P8)

Participant 2 stated that she enjoys PA and feels guilty when she does not participate. This assists the participant in perfecting the skill, improving himself/herself, and improving body appearance.

……PA like walking and jogging that I enjoy. I feel guilty when I don’t do PA even if the weather is bad when it snows but I like to walk a given for about 3 to 4 miles in 1hr.I like perfecting the skill and keep improving everyday as it is good for my health and improves my body appearance. (P2)

Participants in the interview dataset volunteered and took part in PA and stated several benefits for example satisfaction and fulfilment. A participant remarked:

…. I also like walking and running for my mental health. I enjoy doing extra exercises as part of my PA to support my community, such as running for charity events such as cancer charity events. (P12)

Subtheme 2: participant attitudes/behaviour reflection on the importance of PA lifestyle

Participants’ attitudes and behaviour were affected by the COVID-19 lockdown. The stay at home increased sedentary behaviour, with unintended adverse outcomes affecting both physical and mental health. For instance, participant 3 noted:

……I had a chance to reflect on my personal PA lifestyle and see how I can personally motivate myself. (P3)

Another participant stated:

…. every day in COVID-19 lockdown provided a chance to personally reflect on my PA and new opportunity to move and exercise, which improved mood, sleep, and physical health in the short and long term. (P5)

Participant 8 indicated that COVID-19 lockdown helped reflect on the importance of doing PA and says;

……. the lockdown helped me reflect on the importance of doing physical activities as we were in lockdown for months. I become more conscious, and I knew it was important to stay active and removed barriers that prevented them from exercising, such as allowing them greater freedom over the course of time. (P8)

Discussion

This study aimed to explore experiences related to making healthy PA lifestyle choices during the COVID-19 pandemic in a North-East England University-based adult BAME population. The influence of culture as a theme was generated from the objective, which examined the challenges to improving PA lifestyle choices within an adult BAME population during the COVID-19 lockdown. The influences of an individual’s culture and network can be persuasive and influential in determining their physical and mental wellbeing as well as their PA participation (Koshoedo et al., 2015; Higgins et al., 2019). The findings of this qualitative research demonstrated that an individual’s cultural background and upbringing can significantly influence their perspectives on socially acceptable behaviour, such as physical activities that are suitable for their gender. This study fills in the gap about cultural influence on PA participation, particularly with the lack of primary qualitative studies on African populations (Ige-Elegbede et al., 2019). Ige-Elegbede et al. (2019), a systematic review conducted in the UK, suggested that there are links between PA and cultural-social expectations. Cultural perceptions of PA were some of the barriers leading to limited PA engagement among Teesside University adult BAME students. These study findings were obtained during the COVID-19 lockdown and demonstrated an exacerbated sedentary lifestyle in adult BAME individuals. Ige-Elegbede et al. (2019) highlighted cultural and social issues that were leading to sedentary behaviours in the UK. It could be argued that due to cultural barriers as well as the corona virus being a highly transmissible mutant virus with multiple strands, adult BAME individuals were restricted from living an active PA lifestyle. This meant that both non-BAME and BAME individuals faced several lockdowns and uncertainty about their future. In addition, living a PA lifestyle was challenging as individuals feared the highly transmissive Corona virus, which was both asymptomatic and symptomatic (Mbabazi, MacGregor, et al., 2022).

The researcher asked the participants in this study how culture influences their lifestyle decisions in relation to PA, and the responses varied. Some participants indicated that their cultural practices and religious responsibilities take precedence over PA (Table 3). This finding agrees with the study of Ige-Elegbede et al. (2019), who referred to religious fatalism as a practical challenge and indicated a gap in research among black African groups. According to these research findings, cultural practices and religious roles and responsibilities of some ethnic minorities take priority over PA, which restricts PA schedules, programmes, and engagement. In addition, participants highlighted how cultures dictate women’s dressing, for instance, in swimming costumes, sportswear, and cycling clothes that expose the body. The female participants indicated that their cultural practices and religious responsibilities take precedence over their participation in PA. This means that women should consider and prioritise their culture and religion while making decisions about how they dress both inside and outside the house.

The second theme capability to engage in a PA lifestyle was derived from views in the participants’ dataset (Table 3) that went beyond the level of data description (Braun & Clarke, 2022). Using the COM-B model, physical and psychological barriers subthemes were generated which ultimately led to the generation of the main theme. Furthermore, this study successfully mapped its findings to subcategories on the COM-B model (Figure 1) using the interview dataset. As a result, this study provided novel findings because this is the first primary qualitative study that has mapped PA perceptions and experiences of only adult BAME individuals in the Northeast part of England onto the COM-B model during the COVID-19 pandemic. The findings in this study demonstrated that making PA lifestyle choices during the COVID-19 pandemic in adult BAME individuals was challenging in several ways. They demonstrated that adult BAME individuals faced physical and psychological barriers that limited their ability to live a PA lifestyle. This study’s findings are comparable to those of Roche et al. (2022), who generated a study that explored both BAME and non-BAME adults using a quantitative research approach.

The COM-B model (Figure 1) highlighted similar findings of physical and psychological barriers in adult British individuals as demonstrated in Roche et al. (2022). The difference with this study is that these barriers were exacerbated in adult BAME individuals during the COVID-19 lockdown. The study by Roche et al. (2022) as well as all existing literature that applied the COM-B model attained generalised findings that are not representative of adult BAME individuals. According to the literature, the majority of BAME individuals lived sedentary lifestyle before the COVID-19 lockdown when compared to Caucasians (Ige-Elegbede et al., 2019). Several studies have highlighted that the majority of BAME individuals suffer more from sedentary lifestyle diseases compared to their Caucasian counterparts (Booth et al., 2012; Ige-Elegbede et al., 2019; Knight et al., 2021).

This study findings also indicated that adult BAME individuals who could engage in outdoor PA were limited to participate in PA during the COVID-19 lockdown due to the prevention and control measures of a highly transmissive mutant Corona virus. BAME individuals encountered psychological barriers, such as fear, stress, worry, anxiety, and depression. The consequences and impact of the COVID-19 lockdown exacerbated psychological barriers for both BAME and non-BAME individuals. The findings of this study were in conformity to that of Ai et al. (2021) that during the COVID-19 lockdown, individuals experienced a deterioration in their mental health, and an increase in psychological distress such as stress, anxiety, depression, and feelings of isolation. More so, PA participation of BAME individuals was limited due to the COVID-19 lockdown and isolation which resulted in mental health issues that lowered their immune systems thereby making them susceptible to hospitalisation and death (Ai et al., 2021; Khan et al., 2023).

The third theme generated from the participants data was the self-reflective determination model. Participants were asked if there were any benefits to participating in regular PA during the COVID-19 lockdown. Their views generated latent codes and captured the assumptions underpinning surface meanings or pre-existing theories and concepts used to interpret the data leading to two subthemes which include participant-maintained levels of PA participation are down to inner motivation and participant attitudes or behaviours reflect the importance of a PA lifestyle (Table 3). The research data revealed that participants’ attitudes and behaviours reflected their understanding of the importance of an active lifestyle. The adult BAME individuals’ experiences confirmed that the self-determination theory needed to be modified to the self-reflective determination model in order to represent minority ethnic views and give a correct representation rather than a generalisation. Participants’ strengths and weaknesses can be found not only in their barriers and facilitators to PA participation but also in their perceptions that are highlighted in the subthemes. This is because participants’ abilities to live a PA lifestyle are not the only factor that determines whether or not they can participate in PA.

This current study findings recommended that the self-determination theory be modified to the self-reflective determination theory (Figure 1). This current study suggested that it would be difficult to understand if all participants went through the entire reflective process. For example, the Gibbs reflective model suggests following systematic stages of reflection: description, feelings, evaluation, analysis, conclusions, and action plan. The Gibbs model recognises the importance of feelings in reflection. It also separates out evaluation (what went well and what did not) from action. These additional steps make the self-determination theory appropriate for determining whether adult BAME individuals went through the entire reflective process. More research is needed to understand from this current study findings if all adult BAME individuals went through all the stages of reflection.

Several adult BAME individuals reflected on their PA lifestyles prior to and during the COVID-19 lockdown and they were receptive to changing from their sedentary to an active PA lifestyle. Some participants were contemplating continuing to participate in PA, but experienced challenges to living a PA lifestyle during the COVID-19 pandemic due to government restrictions and the subsequent COVID-19 lockdowns. In the literature, studies have generalised adults’ attitudes towards PA participation, which are not representative of the attitudes of adult BAME individuals in this study (Stalsberg & Pedersen, 2018; Ige-Elegbede et al., 2019; Hackett et al., 2020).

This current study provided novel findings and fills in the gap in the COM-B model when it mapped the findings of adult BAME individuals of self-reflection (extrinsic motivation by outside factors) onto the motivation element of the COM-B model (Figure 1). The reflective aspect of adult BAME perceptions and experiences during the COVID-19 lockdown, despite some emerging primary studies (Hailey et al., 2022; Roche et al., 2022), presents generalised findings with mixed ethnicity. There is a paucity of both primary and secondary research regarding the PA self-reflection and participation of adult BAME individuals during the COVID-19 pandemic. Therefore, the findings of this study, that captured the PA experiences and self-reflection during the COVID-19 lockdown, are novel because they are specific to adult BAME individuals.

This current study established that participants-­maintained levels of PA were due to inner motivation, hence the subtheme ‘Participants maintenance of PA participation levels is too low’. Motivation in this context existed on a continuum where individuals were either not motivated extrinsically, intrinsically motivated, or self-motivated. Motivation for the adult BAME individuals’ perceptions towards PA was attributed to being healthy, living with guilt, and their physical appearance. These findings are similar to those of Lucibello et al. (2020), Although the findings in a study there are similar to those of this study, they were generalised and did not represent adult BAME individuals, COVID-19 lockdown, or the Corona virus pandemic.

Additional findings in this current study were that adult BAME individuals indicated that inner motivation drove them to continue living a PA lifestyle. The data revealed that participants were involved in jogging, step counting, voluntary running for charity, self-motivation, self-reflection, and desirable ambitions for their bodies. Newly formed attitudes and behaviours, despite the lack of general engagement during the COVID-19 lockdown, allowed some participants to maintain some levels of PA due to their own inner motivation (self-determination). Similarly, several adult BAME individuals demonstrated that self-motivation, growth, fulfilment, and enjoyment were key reasons for living a PA lifestyle. It can be argued that participating in voluntary PA can be extremely beneficial to one’s health. Participating in PA charity races and volunteering, according to Yeung et al. (2017) and Mbabazi, Nalweyiso, et al. (2023), is a strong predictor of better mental and physical health, satisfaction with life, self-esteem, happiness, less depression, psychological distress, death, and inability to function. It is clear that adult BAME individuals, according to the data, volunteered and took part in PA and stated several benefits, including satisfaction and fulfilment.

This study, participants were receptive to changing from a sedentary to an active PA lifestyle. Through adult BAME individuals’ self-reflection on the importance of PA on their personal fulfilment and satisfaction in engaging in voluntary charity races, they were able to self-reflect on their PA behaviour and attitude towards PA. It can be recommended that personal reflection helps us to understand our own intrinsic motivations towards a behaviour, including our PA lifestyle. In addition, being physically active helps to improve mental health, self-esteem, confidence, the quality of life, motor skill development, strengthen bones, and cognitive functions as well as reduce cardiovascular risks and weight gain. Therefore, self-reflective determination theory is important to improve PA lifestyle in adult BAME individuals.

In contrast to the findings of the study by Teixeira et al. (2012), the findings of the current study show that adult BAME individuals only require extrinsic motivation to improve skills and achieve growth when leading a PA lifestyle. The findings of Teixeira et al. (2012) are like those of this current study, but they are also generalised findings that are not specific to adult BAME individuals. The current findings of adult BAME individuals established changes and shifts in their PA lifestyle during the COVID-19 pandemic.

Study strength and limitations

This study used qualitative research method, which led to more in-depth data and explored issues affecting adult BAME individuals regarding PA participation. The study is the first of its kind, therefore producing novel findings and adding to the body of research knowledge that can be used to improve PA culturally related policies. Thematic reflexive analysis was used as a strength for this study because it is feasible in this research context to contextualise information or make sense of data, which is uniquely flexible and appropriate.

TA is not tied to a particular framework and can be conducted in different ways that can be inductive or theory-driven. More research is needed to understand from the current study’s empirical findings whether all adult BAME individuals went through all the stages of reflection. This is one of the limitations of the current primary research. The COM-B model in this study can be used to consider intervention components for increasing PA participation in future pandemics and lockdowns. In addition, the novel qualitative findings of PA in adult BAME individuals can help public health experts and researchers combat mental health issues by using PA as a way of socialising.

The current qualitative study led to a modification of both the COM-B and the self-determination models, which is a novel application for future PA interventions that can lead to improved PA policies and participation that can eventually lead to lower mortality rates among adult BAME individuals.

Implications for policy and practice

The study demonstrated the influence of culture on PA, with an increased tendency for the BAME population to consider culturally accepted practices when deciding on a PA lifestyle. This was a novel finding of this study that has been identified as under-researched in the UK. Therefore, policymakers need to consider culture when developing PA interventions that have been identified as a barrier to PA engagement among adult BAME individuals in Europe, Australia, and the USA (Moreno-Llamas et al., 2020; You et al., 2021).

Consequently, despite the cultural barriers faced by BAME individuals, their culture plays a significant role in keeping this group together. It can, therefore, be argued that cultural dance events benefit adult BAME individuals’ mental health and well-being. There is more research needed to ensure that public health experts understand the meaning of body image in the BAME context. Culture plays a vital role in body image. Consequently, despite the cultural barriers faced by BAME individuals, their culture plays a significant role in keeping this group together. For example, during cultural dancing ceremonies, the dancers relax their bodies and enjoy their time (Vinesett et al., 2015).

The COM-B model is an existing behavioural model that has been used to identify what needs to change for a behaviour change intervention to be effective. It has been used in the literature to provide generalised results for non-BAME and BAME adults prior to COVID-19 pandemic. However, to improve the PA lifestyles of adult BAME individuals, there is a need to establish specific interventions for these individuals. Adult BAME individual perceptions regarding PA during the COVID-19 pandemic were mapped onto the COM-B framework to help understand BAME individuals’ attitudes and behaviours to PA participation and to inform future interventions. In line with the current study findings, future interventions should focus on promoting facilitators and reducing barriers to PA participation through strategies such as increasing PA participation, enhancing access to PA related resources, providing knowledge, and promoting the positive physical and mental effects of PA.

The current qualitative findings argue that low socio-economic status may not be limited to BAME individual groups but could include some non-BAME groups. BAME individuals lack PA infrastructures such as recreation centres and parks that could facilitate their PA engagement. In addition, based on these same novel findings, it is imperative that the government develop health promotion educational programmes that could improve PA lifestyle and raise awareness among BAME individuals.

Recommendation

Although there have been successful PA interventions regarding theoretical frameworks used by researchers, such as the COM-B model, PA interventions regarding adult BAME individuals using behaviour change models are under-researched. There is a need for more primary research to modify or develop new behavioural change models that are specific to adult BAME individuals to combat sedentary lifestyles and sedentary lifestyle diseases. PA health interventions are required to address a variety of needs, for example, stress, depression, obesity, increasing self-esteem, etc.

This study revealed that there are several government and public health guidelines and policies regarding PA. More research is required to evaluate the effectiveness and implementation of published guidelines and policies on PA, specifically among adult BAME populations. Research should explore the access to and uptake of available PA resources among adult BAME individuals. This recommendation is significant as the majority of adult BAME individuals live at a low socio-economic status, meaning they cannot afford to pay daily fees for recreation centres and gyms in order to live an active PA lifestyle. Most of the previous studies on PA participation barriers and facilitators among BAME in the UK focused on Muslims from South Asia, and it appears that there are gaps in the evidence of barriers and facilitators of PA participation among immigrant groups and specifically individuals of African descent in the UK. Therefore, a recommendation is made for future studies to identify PA participation barriers and facilitators among adult BAME populations in the UK.

Conclusion

This current qualitative study is the first to look at the experiences of adult BAME people who chose to live a healthy PA lifestyle during the COVID-19 pandemic. Using thematic analysis, three main themes were found. These include the influence of culture on the PA lifestyle, the capability to engage in the PA lifestyle, and the self-reflective determination model. The themes of the study were mapped onto the theoretical frameworks to help understand the PA behaviours and experiences of adult BAME individuals as well as inform future interventions. The study has modified the COM-B model including the self-determination theory into the self-reflective determination theory. This study captured specific BAME experiences and perceptions regarding making healthy PA lifestyle choices during the COVID-19 pandemic. Several intervention functions have been successfully mapped to sub-categories of the COMB model. Nevertheless, limited studies have used lifestyle behaviour models to enhance behavioural modification. When adapted, this could help improve culture of PA participation related policies for adult BAME individuals globally.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Johnson Mbabazi

Johnson Mbabazi, an associate lecturer at Teesside University. He is also the Co-founder and chairman of the Teesside University Health Students Research Network. He is a Fellow of the Royal Society of Public Health, a Fellow of the European Public Health Association, and an associate of the Royal College of Physicians. He has published a lot of peer-reviewed articles and books. A multiple international award-winning author and UK Plaque winner.

Fiona MacGregor

Fiona MacGregor is a Principal Lecturer for International, SHLS Allied Health at Teesside University and part of the member of the Teesside University Health Student Research Network (TUHSRN).

Jeff Breckon

Jeff Breckon is Associate Dean for Research and Innovation in the School of Health and Life Sciences at Teesside University and Co-founder of TUHSRN.

Barry Tolchard

Barry Tolchard is Director of Integrated Care Academy and a Co-founder TUHSRN.

Edward Kunonga

Edward Kunonga is a lecturer and a member of TUHSRN at Teesside University.

Dorothy Irene Nalweyiso

Dorothy Irene Nalweyiso is Doctor of Public Health at Teesside University, part time lecturer at Makerere University and an executive committee member TUHSRN.

Abiola Fashina

Abiola Fashina A Biomedical scientist and a Public Health master’s student at Teesside University and an executive TUHSRN.

Lawrence Achilles Nnyanzi

Lawrence Achilles Nnyanzi is a Senior Lecturer in Research Methods Programme Leader Doctorate in Public Health and a Co-founder of TUHSRN.