Physical activity perceptions and experiences of BAME Teesside University students during the COVID-19 pandemic: a qualitative study

Abstract

The study sought to explore the barriers and facilitators for making physical activity lifestyle choices among Black Asian Ethnic Minority (BAME) students at Teesside University during the COVID-19 pandemic. A qualitative approach was used to capture the in-depth physical activity experiences of BAME individuals. There is a paucity of primary qualitative studies focusing on BAME individuals’ activity lifestyles prior to and during the COVID-19 lockdowns between April and August 2020. BAME individuals faced exacerbated physical, psychological, social, and institutional barriers which are mapped onto the capability, opportunity, and motivation model of behaviour (COM-B). Twelve BAME participants were interviewed via Microsoft Teams using semi-structured interviews lasting 45 to 60 minutes. Using thematic analysis, we identified seven themes; the two primary ones were barriers and facilitators to being active and were successfully mapped onto the modified COM-B. Although existing literature has used the COM-B, these were primary quantitative findings that did not enable an in-depth exploration of BAME individuals lived experiences of physical activity participation during COVID-19. Thus, the COM-B model was modified to reflect this research’ qualitative approach, through which improved policies and implementation strategies may be applied specifically to BAME individuals.

IMPACT STATEMENT

This research is the first primary qualitative study that has mapped physical activity perceptions and experiences of British Asian Minority Ethnic (BAME) University students at a Northeast of England University during the COVID-19 pandemic. The findings demonstrated that physical activity participation was limited due to social, institutional, and psychological barriers in this student population during this time. A key contributing factor was that those participants not vaccinated at this time were less confident about exercising with others. This research findings are transferable to some non-BAME groups of low socio-economic status that prohibit regular gym membership that could facilitate their PA participation. Based on the research findings, it is imperative that the UK government develops future interventions that aim at modifying behaviour models in order to facilitate an understanding of the specific barriers and facilitators for BAME individuals. This could help improve culture of physical activity participation related policies for BAME individuals nationally and subsequently their long-term health.

Keywords:

• BAME
• physical activity
• covid-19
• barriers
• facilitators

Reviewing Editor:

• Joe Thomas, Institute of Health and Management, Australia

SUBJECTS:

• global health
• health education and promotion
• population health

Introduction

Coronavirus 2 (SARS-CoV-2) was a new strain of coronavirus that had never been seen before (Pal et al., 2020; Pears et al., 2022). The coronavirus sickness of 2019 was a serious disease that poses a significant risk to people’s lives (Dhama et al., 2020). It is a beta-CoV that belongs to group 2B and is the virus that causes the disease known as COVID-19 (Zheng, 2020). Our knowledge of SARS-CoV-2 has been filled with just as much controversy and mystery as the disease it caused (Dhama et al., 2020; Zheng, 2020). COVID-19 quickly spread worldwide and became a pandemic that has infected every continent (Ke et al., 2020). On 30^th January 2020, the World Health Organisation (WHO) labelled the Corona virus outbreak a public health emergency of global concern, and on 11th March 2020, the WHO labelled the outbreak a worldwide pandemic (Ke et al., 2020).

The European Centre for the Prevention and Control of Disease estimated 5,899,866 cases of COVID-19, including 364,891 deaths (Singhal, 2020) between 31^st December 2019, and 30^th May 2020, following the applied case definitions and testing strategies in the affected countries. By the 30^th May 2020, the UK registered 272,607 deaths, and the USA registered 1,747,087. The COVID-19 pandemic had a significantly negative social impact, leading to feelings of isolation, mental health concerns, financial pressure, limited outdoor physical activity (PA), and closed communal areas (Marroquín et al., 2020). This was further exacerbated by the need to spend more time at home, using only local parks, and open areas (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 has great potential as a coping and preventative strategy (Mahindru et al., 2023). Studies have shown that PA helps prevent chronic illnesses, including cardiovascular disease, diabetes, and obesity whilst also enhancing cognitive performance, and mental health (Pedersen & Saltin, 2015). In the UK, according to government Coronavirus (COVID-19) advice on accessing green spaces safely, individuals were told to use their back gardens and take only limited walks to the parks (GOV.UK, 2020). The WHO has promoted PA due to its health advantages, increasingly emphasising environmental initiatives to further encourage engagement (Dai & Menhas, 2020). England’s chief medical officer Professor Whitty promoted the need for active lifestyles and walkable communities at this time however, due to public safety restrictions minimal PA benefit was attained. For many the COVID-19 pandemic simply exacerbated sedentary lifestyles, leading to some BAME individuals living with non-communicable diseases increasing their risk of death (Hall et al., 2021; Mbabazi et al., 2022a). Despite having limited outdoor PA opportunities, it was argued that BAME individuals must reduce sedentary behaviour by performing indoor PA. While considering health-promotion strategies and interventions, emphasis was placed on the nature of individuals’ interactions with their physical and sociocultural environments from an ecological perspective. The focus being on the need to address environmental factors through which changes and health-related behaviours could be improved (Springer et al., 2017).

The COM-B is a tool for analysing behaviour that can be applied to individuals, subgroups, populations, and organisations (Michie et al., 2011; Mbabazi et al., 2023). The reflective element of the COM-B involves self-consciousness and planning, while the automatic element involves wants, needs, and desires (Liu et al., 2023; Mbabazi et al., 2023). This model has proven to be a useful tool to be modified to facilitate lasting and effective behaviour change (Michie et al., 2011; Timlin et al., 2021). This has been extensively and reliably used to target and explain changes in human behaviour, particularly in relation to PA (Howlett et al., 2019). This model was used due to its ability to facilitate the capturing of BAME participants personal experiences of engaging with PA during the COVID-19 lockdowns and social restrictions.

Mansfield et al. (2021) suggests that COVID-19 affected physical and mental health in most individuals in the UK and globally. The pandemic reduced PA globally by up to 50% (Park et al., 2022). There are currently no primary studies which explore the extent to which ethnic minority individuals with a low social and economic lifestyle were affected during COVID-19. This coupled with several confounding factors such as being at a higher risk of having non-communicable diseases such as diabetes, heart problems, hypertension, highlights the need for research within this setting. The pandemic resulted in many enforced behavioural changes together with the need to reconsider on a national scale all facets of life previously taken for granted, including public spaces and housing conditions (Phiri et al., 2021). Mbabazi et al. (2022a) systematic review of qualitative studies, established that no studies had been undertaken within this remit which focused specifically on BAME individuals.

Rationale for the study

Compared with non-BAME individuals, those from BAME communities have been reported to have poorer health outcomes in response to various medical interventions (Ajayi, 2021). There exists a lack of empirical research exploring attitudes to and perceptions of PA among the BAME population in regard to its potential role in lifestyle enhancement and disease prevention (Albert et al., 2020). A range of facilitators and barriers have been identified impacting on PA lifestyle choices among UK BAME individuals, including individual, structural, environmental, and social domains (Mbabazi et al., 2022b). There is even less research regarding ethnicity and culture’s role in forming physically active lifestyle choices (Ige-Elegbede et al., 2019; Mbabazi et al., 2022a). Mbabazi et al. (2022a) conducted A systematic review of a systematic review (overview) conducted by Mbabazi et al. (2022a) using the Cochrane database established that no reviews had been conducted regarding the experiences or perceptions of PA among BAME individuals during the pandemic. Subsequently, Mbabazi et al. (2022a) undertook a systematic review of qualitative studies, which again identified a lack of primary research in this setting.

Previous research has investigated the barriers discouraging individuals from participating in PA (Koh et al., 2022), however there remains a lack of research on the difficulties faced by older BAME individuals (Katito & Davies, 2021). They found that racially diverse groups had significantly different cultural conceptions of PA and barriers to participation in PA. Studies have highlighted that the majority of BAME individuals are identified as having a high body mass index (BMI), being seen as overweight, obese or morbidly obese (Fruh, 2017; Vranić et al., 2019). This presents an increased risk of living with chronic non-communicable disease together with compromised immune systems. As was highlighted during the peak of the pandemic within the mass media, this led to a significantly disproportionate number of BAME individuals contracting COVID-19, with often more serious outcomes, including long-term covid and even death (Saqib et al., 2023). The dearth of primary research regarding this topic necessitated the undertaking of this research study.

Aim

This research sought to explore the physical activity perceptions and experiences of BAME students at Teesside University during the COVID-19 pandemic. This had the additional aims of seeking to gain insights into participants understanding of the health benefits of PA, their pre-contemplation and contemplation of performing PA, reasons for giving up PA, facilitators and barriers to PA, and the influences their ethnicity and culture had on their choices made.

Methods

This qualitative research was conducted at Teesside University in the northeast of England, UK. This formed part of a larger doctoral research project and consisted of individual, semi-structured interviews, undertaken through Microsoft Teams. This was used in preference to face-to-face to minimise the potential spread of COVID-19 (Singh & Awasthi, 2020). Each interview was audio recorded and transcribed by the lead author. Manual coding was undertaken with the collected data following Braun and Clarke (2023) 6 stages of Thematic analysis. This enabled a thorough evaluation of the participants own perceptions and experiences (Alsaigh & Coyne, 2021), thereby enabling an exploration of the barriers and facilitators to physically active lifestyle choices during the COVID-19 pandemic in BAME students at Teesside University. This research was granted ethical approval via the Teesside University Health Research Ethics Sub-committee (2022 Mar 7747 MBABAZI).

Sampling and recruitment

BAME participants living in the UK and students at Teesside University were purposively recruited through the Teesside University community network. An advertisement was posted on the University’s Virtual Learning platform on the Blackboard module platform inviting interested participants to contact the lead researcher. A participant information sheet was provided to all potential participants informing them of the research purpose and was entailed. Prior to the beginning of the interviews, consent was obtained from each participant using the participant consent form. Participants were informed that providing consent was completely voluntary and that it could be withdrawn until which time the interview was transcribed and anonymised. Participants were advised that all the data obtained, would be securely stored on a password protected server at Teesside University.

Data collection

Data was collected using semi-structured interviews, lasting no more than 45 minutes. Microsoft Teams was used to capture and transcribe the interviews. All the interviews were conducted online, enabling minimal disruption to the participants, whilst also facilitating the development of a relationship between interviewer and participant (Williamson & Burns, 2014). This is invaluable when seeking to explore insights and feelings (Busetto et al., 2020). A reflective logo and a memo were also used as an additional tool to enhance the ability to conceptualise the data recoded. To enhance the credibility of this research, sustained engagement in the field was maintained over a yearlong period. To increase the reliability of the data Twelve follow-up interviews were also conducted with eight participants willing to add more detail to their accounts with six of these agreeing to review their interview transcripts and provide feedback, thus affirming data transferability between the research participants and the researchers (Elo et al., 2014; Forero et al., 2018).

Data analysis

An inductive approach was used during data analysis to allow the researcher to broaden the analytic field of vision by first familiarising themselves with the dataset (Byrne, 2022). The data was analysed using thematic analysis in line with the stages advocated by Braun and Clarke (2023) for semantic or latent codes, subthemes, and themes (Figure 1). This analysis was undertaken manually, enabling the researcher to be attentive to the participants’ language, nonverbal communication, and pauses (Pereira et al., 2021). It was felt that the 12 interviews conducted demonstrated sufficient in-depth data to be able to effectively address the research aims (Ando et al., 2014; Mbabazi et al., 2023). To minimise insider bias within this study, alternative interpretations were also considered (Sutton & Austin, 2015), together with the maintenance of a reflective log (Byrne, 2022), and the reviewing of the themes developed by another member of the research team (JB).

Figure 1. A six-stage method of thematic analysis adapted from (Braun & Clarke, 2023).

Results

Twelve BAME students were recruited from Teesside University. Their demographic breakdown can be seen in Table 1, demonstrating the ethnic breakdown by gender and number of participants and data collection. To ensure the participants confidentiality, they were each assigned a unique reference number, from 1 to 12.

Table 1. Social- demographic characteristics of participants.

	Age			Gender		Ethnicity
Participant code (Participant number Interview number)	28-35	36-45	46-52	Male	Female	Black or Black British- African	Asian British- Indian
	6	5	1	6	6	9	3
	Background			Gender
Participant 1	Asian			Female
Participant 2	Asian			Male
Participant 3	Asian			Female
Participant 4	Black African			Female
Participant 5	Black African			Female
Participant 6	Black African			Female
Participant 7	Black African			Female
Participant 8	Black African			Male
Participant 9	Black African			Male
Participant 10	Black African			Male
Participant 11	Black African			Male
Participant 12	Black African			Male

Through analysis of the collated data the themes were refined into ten main categories, from which five subthemes and two are presented relating to the experiences of BAME individuals and the healthy lifestyle choices made relating to PA during the COVID-19 pandemic.

The two overarching themes identified were ‘capability to engage in physical activity’ and ‘facilitators or barriers to physical activity’. Table 2 demonstrates these themes and the participants contribution to these themes, with Table 3 highlighting the process of this theme development.

Table 2. Themes and participant contribution.

Major Theme	Participant number
	01	02	03	04	05	06	07	08	09	10	11	12
Capability to engage in a physically active lifestyle		✓	✓	✓		✓	✓			✓	✓	✓
Facilitators or barriers to participating in physical activity	✓	✓	✓		✓		✓	✓	✓			✓

Table 3. A summary of the process of key theme development.

Supporting Quotes	Latent Codes	Subthemes	Key Theme
‘……. I am limited due to injuries, pains in joints and fatigue. But for performing severe physical activity is so difficult’	Knee pain, ankle pain, pregnancy, injuries, age	Physical barriers	Capability to engage in physically active lifestyle
‘…. this means that I cannot do physical activity because I have knee pain and ankle pain. I tried it, and I couldn’t do it. I’m not so capable’
‘……. actually, I feel very capable of doing physical activity, but I’m limited by my age. I need to be stronger to maintain my muscles so that I can continue to live a very active life… this also limits my choice of physical activities as I am in my late 40’s, almost 50’
‘……. also, restrictions, as I have self-awareness of COVID-19 is transmissible and I don’t want to get infected. I have stress, fear, and worry, that limits my physically active lifestyle due to the risk of getting infected with Corona virus. All these changes limit me, despite the fact that I am still a young Asian man’	Stress, fear, worry, anxiety, depression	Psychological barriers
‘……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. The COVID-19 lockdown made me worry and anxious, and at times I felt it was depressing to pass on the virus to my friends and family members’
‘……It takes me longer to recover. ……am in my late 40s, almost 50. My body is becoming old and weak. I am no longer interest in performing physical activity. I even have limited physical activity choices’	Barrier (Attitude)- lost motivation due to age 40 years, Facilitator (Knowledge/awareness)-Lack of engagement with physical activity leads to a sedentary lifestyle, knowledge: facilitator-physical activity has a great	Facilitators/barriers of physical activity at intrapersonal levels (Psychological barriers)	Facilitators /Barriers of physical activity
‘The fact that I was limited to PA during COVID-19 lockdown affected my mental well-being leading me to get stressed’
‘………I still intend to do physical activities due to a lot of benefits it gives. A good physical and mental health. PA simply enhances my mental health’	influence on mental health/reduces stress, awareness: maintaining a good mental and physical health
‘……. so, it did make me feel a bit depressed because, you know, when you have a target of how you want to look and where you want to be and you’re not consistently getting there because of something that’s happening to you…. The COVID-19 lockdown only worsened my situation.’	health, attitudes: post lockdown I got my confidence to do physical activity, to improve my body image and mental health, lack of time, lack of childcare, lack of support from peers/family, stress, mental exhaustion, depression, fear, death and bereavement, lack of sleep
‘…… I also lack company or social opportunities to do my physical activity, which is important to my physically active lifestyle. I also have self-reflection and a desirable ambition to have a good body shape’	Barrier-. Social support: The situation of getting infected meant you could infect your family and friends, financial support; money limits my physically active lifestyle during COVID-19 lockdown, Barrier: Discouragement: COVID19 lockdown situation was not encouraging, interdisciplinary collaboration: I also lack company or social opportunities to do my physical activity	Barriers of physical activity at interpersonal level (social barriers)
‘……lack of money affects my physically active lifestyle Money limits my physically active lifestyle during the COVID-19 lockdown. This impacts the family’
‘………. unless if you are an essential worker, number of infections and death this has been so difficult and limited my physically active lifestyle. I feared and was stressed. I feared for my life and my family. I wondered and feared for my health in general’
‘………. there were tough government restrictions, and gyms as well as recreation centres and gyms were closed to reduce the number of infections. It was too infections all the time’	Barrier-Physical environment; Feared getting infected and infecting others corona virus,COVID-19 lockdown this limits my physically active lifestyle, barrier: participant activities, there were tough government restrictions and gyms and recreation centres closed to reduce the number of infections, barrier- physical activity procedures: obeying COVID19 government guidelines,sickness, arthritis, injuries, pregnancy, and asthma	Barriers of physical activity at institutional level (physical barriers)
‘……. I feared getting infected and infecting others during COVID-19lockdown it was a set back towards my friends and family. So, this limited my physically active lifestyle’
‘……at times, there were not clear guidelines as well, as this was a novel virus, and even scientists had many things unknown and uncertain’

To be able to explain and garner true insights from the themes identified, the COM-B behaviour change model was applied, as demonstrated in Figure 2.

Figure 2. Summary of mapping of themes onto the COM-B model (Adapted from Roche et al., 2022).

The two themes and five subthemes drew on the COM-B model, whereby participants behaviours could be explained, particularly in terms of their capability to participate in PA, and the perceived barriers or facilitators to PA. This enabled the researchers to have a greater understanding of the influences on the participants behaviours. All participants clearly demonstrated knowledge and awareness of physical activity and the many benefits that it may bring. Although, for most participants (n = 8), the perceived barriers limiting their effective engagement encompassed intrapersonal (psychological barriers), interpersonal level (social barriers) and institutional (physical barriers). A primary issue for nine of the twelve participants was the social isolation and social distancing measures during this time. For many participants (n = 8), whilst the will to re-engage with PA is evident, there is reticence due to ongoing fears regarding COVID-19 and as such now making participation more difficult. The impact of low vaccination uptake within the participants exacerbated this lack of confidence in being safe if exercising with others.

Theme1: Capability to engage in physically active lifestyle

Participants felt that there were physical and psychological barriers that limited their ability to live a physically active lifestyle. Physical barriers were linked to pre-existing joint pain, injuries, respiratory conditions, and age. Whilst psychologically the primary factors related to stress, fear, anxiety, and depression (See Figure 3).

Figure 3. The latent codes informing Theme 1 - ‘Capability to engage in physical activity lifestyle’.

Subtheme 1: Physical barriers

This subtheme manifested itself in several ways among participants, including sports injuries and pain which limited their physical activity lifestyle, as demonstrated in the examples below.

……. I am limited due to injuries, pains in joints and fatigue. But for performing severe PA is so difficult (Participant 2).

…. this means that I cannot do physical activity because I have knee pain and ankle pain. I tried it, and I couldn’t do it. I’m not so capable (Participant 3).

It was not unusual for the participants (n = 8) to link this form of injury to weight gain through an enforced sedentary lifestyle. This was highlighted as a major challenge.

…….in recent times, no. I am not able to live an active physical activity 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. My knee gets this pain that feels more like a treating pain, and once it starts, it takes over 2 weeks before it goes away. So, while it’s there, I feel very uncomfortable (Participant 6).

Respiratory conditions such as asthma, advancing age and pregnancy were also found to be significant factors with five participants identifying these as contributing their incapacity to engage in physical activity. One participant with asthma said:

…. I am asthmatic during physical activities. 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. although this is rare. ‘Being asthmatic somehow limits me’. (Participant 10).

Another participant, when asked about what limits their physical activity lifestyle choices said:

……. actually, I feel very capable of doing PA, but I’m limited by my age. To be honest, as I have grown older, I feel like I need more fitness to walk a long distance and am not as fast as I used to be. I need to be stronger to maintain my muscles so that I can continue to live a very active life …… this also limits my choice of physical activities as I am in my late 40’s, almost 50 (Participant 11).

Subtheme 2: Psychological barriers

Some participants (n = 7) highlighted psychological barriers such as stress, fear, and worry, which limited their physically active lifestyle, primarily due to the fear of due to the fear of contracting COVID-19. 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 (Participant 2).

Due to the Corona virus presenting as symptomatic in some and asymptomatic in other people this increased the fears and anxieties many held, thereby preventing them from proactive engagement in leading an outdoor physically active lifestyle. This was exemplified by one participant:

……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. The COVID-19 lockdown made me worry and anxious, and at times I felt it was depressing to pass on the virus to my friends and family members (Participant 5).

Theme 2: Facilitators/barriers of PA

Several multilevel facilitators and barriers were identified, leading to the generation of three subthemes; intrapersonal (psychological barriers), interpersonal (social barriers), and institutional (physical barriers), as demonstrated in Figure 4.

Figure 4. Latent codes forming the Facilitators/Barriers of PA.

Subtheme 1: Psychological facilitators/barriers at intrapersonal levels

The intrapersonal factors identified included attitudes, levels of self-esteem, the ability to self-regulate, and the ability to make decisions. Seven of the participants highlighted psychological barriers at intrapersonal levels such as ageing. For example, a participant said.

……It takes me longer to recover. ……am in my late 40s, almost 50. My body is becoming old and weak. I am no longer interest in performing PA. I even have limited PA choices (Participant 11).

Some participants (n = 7) however acknowledged their awareness of the advantages of PA in their health, with one saying,

………I still intend to do physical activities due to a lot of benefits it gives. A good physical and mental health. PA simply enhances my mental health (Participant 12).

This view was echoed by another participant, who stated that;

…. we work out physically because it helps us stay motivated. Additionally, maintaining good mental and physical health as well as a positive body image keeps me going. I want to live disease-free in the long term, and I enjoy my retirement (Participants 2).

The data highlighted that having positive attitudes towards PA are some of the primary facilitators for being physically active as demonstrated below;

……….but after the lockdown, I believe I regained my confidence in PA in order to improve my body image and mental health. I am motivated by a desire to have a good body image and to look after my mental health (Participant 5).

Many participants(n = 7) highlighted stress, mental exhaustion, fear, a lack of sleep, bereavement, and depression, as demonstrated in the following examples:

The fact that I was limited to PA during COVID-19 lockdown affected my mental well-being leading me to get stressed (Participant 6).

………I feel like I don’t want to do PA, and all I want is to rest. I am worried if I do not engage in PA. I feel something demanding at the back of my mind that tells me that it won’t help decrease my stress. Also, stress doesn’t permit me to engage in PA because of the COVID-19 lockdown (Participant 1).

The statement from Participant 12 exemplifies this:

……. so, it did make me feel a bit depressed because, you know, when you have a target of how you want to look and where you want to be and you’re not consistently getting there because of something that’s happening to you…. The COVID-19 lockdown only worsened my situation. (Participant 12).

Subtheme 2: Barriers of PA at the interpersonal level

Barriers to physical activity at the interpersonal level included a lack of social support, financial support, discouragement, and interdisciplinary collaboration. Lack of social support for PA was remarked on:

…… I also lack company or social opportunities to do my physical activity, which is important to my physical activity lifestyle (Participant 6).

Participants emphasised the importance of families and friends as fundamental support for physical activity participation. However, due to the COVID-19 lockdown, these could not be readily accessed unless they were part of your selected group as indicated by Participant 5:

………. the situation of getting infected meant you could infect your family and friends also. This means you could not engage in physical activities, and I had no plans to do any physical activities until it was safe. Unless you were in the same household, The situation was so scarily that this was also not encouraging (Participant 5).

Financial support was also identified as a significant barrier during this time:

……lack of money affects my physical activity lifestyle. Money limits my physical activity lifestyle during the COVID-19 lockdown. This impacts the family (Participant 2).

The COVID-19 lockdown led to home confinement that resulted in a decrease in all levels of PA as well as increased in unhealthy sedentary lifestyle. This was noted by many participants (n = 11) as indicated below:

………. unless if you are an essential worker, number of infections and death this has been so difficult and limited my physical activity lifestyle. I feared and was stressed. I feared for my life and my family. I wondered and feared for my health in general (Participant 3).

Subtheme 3: Barriers to PA at the institutional level

The intrusion of the COVID-19 virus into all aspects of participants lives was a major concern to most participants, particularly in those areas where they had previously engaged in PA:

……. I feared getting infected with corona virus, so, this limited my physical activity lifestyle and engagement (Participant 7).

Perhaps the most significant barrier to engaging in PA at this time were the institutional barriers imposed nationally by the government, resulting in enforced loss of freedom to meet and interact with others but also the closure of sports facilities and gyms.

………. there were tough government restrictions, and gyms as well as recreation centres and gyms were closed to reduce the number of infections. It was too infections all the time (Participant 9).

The problem with the COVID-19 lockdown is that we all had to stay at home with very limited indoor PA and feared getting infected if we went out. So, we were very limited to doing a few hours of PA in the park outside. At times, we didn’t do anything (Participant 1). 

Moreover, some participants (n = 6) also suggested that there was a lack of clear guidance on many aspects of life, resulting in mixed messages and uncertainty regarding what could and should be done:

……at times, there were not clear guidelines as well, as this was a novel virus, and even scientists had many things unknown and uncertain (Participant 1).

Discussion

Theme1: Capability to engage in physical activity lifestyle

The theme, ‘capability to engage in a physically active lifestyle’ was derived from views in the participants’ expressed experiences and insights (Figure 3) that went beyond the level of simply data description (Braun & Clarke, 2023). Using the COM-B model, physical and psychological barriers subthemes were generated which ultimately led to the generation of this first main theme. Eight of the twelve participants (Table 2) led to the generation of the theme in this study. Capability in this context consists of having the necessary knowledge, abilities, and skills to engage in PA (Michie et al., 2011).

The findings in this study demonstrated that making physical activity lifestyle choices during the COVID-19 pandemic for BAME individuals was challenging in several ways. They faced physical and psychological barriers that limited their ability to live a physically active lifestyle. The application of the COM-B model (Figure 2) highlighted similar findings of physical and psychological barriers in non-BAME individuals as demonstrated in Roche et al. (2022). Although Roche et al. (2022) successfully mapped themes onto the COM-B model, their findings were quantitative, not in depth, and generalised, thus not specifically representative of BAME individuals. Recognition of this is needed since as indicated at the outset of this paper members of the BAME have unique factors that cannot be generalised to wider population demographics.

This study established that certain barriers were exacerbated among BAME individuals during the COVID-19 lockdowns and subsequent restrictions on social movement. An important factor within this was that the majority of BAME individuals were already living a sedentary lifestyle prior to the onset of the pandemic when compared to their Caucasian counterparts (Ige-Elegbede et al., 2019; Knight et al., 2021). This was particularly prevalent in the northeast of England, and the Teesside region, which is identified as an obesogenic environment, with 75% of residents being overweight (Middlesborough Moving Forward, 2016).

The Social Metrics Commission revealed that nearly half (46%, 90,000 individuals) of those living in Black/African/Caribbean/Black British households were poor, compared to just under one in five (19%) of those living in a Caucasian household (GOV.UK, 2020). However, it could be argued that some non-BAME individuals are of a similar low social and economic status as these BAME individuals. Thus, the COM-B model should be modified not only to represent BAME individuals as an ethnic group but also to represent other ethnic groups of low social and economic status.

This research established that whilst there were some BAME individuals who could engage in outdoor PA this was limited during the COVID-19 lockdown due to the prevention and control measures implemented by the Westminster government for England, UK. BAME individuals encountered psychological barriers, such as fear, stress, worry, anxiety, and depression, feelings not unlike those experienced by many other population groups within the UK, further compounding pre-existing barriers.

Theme 2: Facilitators/barriers of PA

This second key theme was generated from three subthemes including facilitators or barriers to PA at intrapersonal levels (psychological barriers), barriers to PA at an interpersonal level (social barriers), and barriers to PA at an institutional level (physical barriers), (Figure 4). Eight of the twelve participants contributed to the generation of this theme. This study found that PA participation among BAME students was affected by several factors at the intrapersonal, interpersonal, and institutional levels.

This study demonstrated diverse responses from the participants regarding a change in motivation for their physically active lifestyle at intrapersonal level. The majority of the participants reported multiple factors that affected PA participation at the intrapersonal levels, including motivation to maintain physical and mental health, knowledge and awareness, time, resources, socio-economic status, emotions, and attitudes.

At the intrapersonal level, the findings established that there were knowledge, awareness, and attitude of PA engagement, with some participants (n = 7) acknowledging their awareness of the benefits of PA. The intrapersonal factors identified within this study included attitudes, levels of self-esteem, the ability to self-regulate and make decisions. The participants acknowledged that knowledge and awareness of PA benefits including mental health, were their major facilitators of their physical activity lifestyle. Albert et al. (2020), found similar results, concluding that knowledge, awareness, positive mental health, and confidence are all significant in PA participation. These current findings indicated that age was among the factors that affected participants’ attitudes towards PA engagement. Findings replicated by Valaitis et al. (2018) and Yarmohammadi et al. (2019) who suggested that important motivators and barriers to PA are closely related to age. More prevalent within this and other studies was the significance of stress, mental exhaustion, depression, fear, lack of sleep, lack of childcare, lack of support from peers/families, in impacting on PA engagement (Marashi et al., 2021; Winfield et al., 2023). With the heightened experiences of many in the UK, particularly within the BAME population of death and bereavement due to COVID-19, this proved a significant psychological impediment to participating in PA (Marashi et al., 2021; Winfield et al., 2023). Marashi et al. (2021) also determined that PA could protect mental health, as such ongoing psychological support is needed to overcome these barriers to PA participation exacerbated during stressful times like the COVID-19 lockdown.

The BAME students in this current study highlighted the importance of families and friends support in enhancing their physical activity lifestyle. However, due to the COVID-19 lockdown, participants could not access family members to undertake social physical activities. Hailey et al. (2022) presented similar results where the majority of individuals were affected by a lack of social support, loneliness, and social isolation impacting on their physical activity lifestyle during the COVID-19 lockdown. These findings however are not specific to BAME individuals therefore, they cannot be considered a true representation of the BAME populations. It could be argued that the importance of social support for the long-term maintenance of physical activity lifestyle needs to be extended to the contexts of social restrictions thereby helping to close the gap should similar pandemics occur in the future. These intrapersonal barriers established in this study call for the modification of the COM-B model that facilitated the capture of the social experiences of BAME individuals. Identification of these barriers expressed within this paper are the first of their kind in such extremis circumstances, such a modified COM-B model could also be applied to other ethnic populations and people in similar low socio-economic status groups (Roche et al., 2022; Ige-Elegbede et al., 2019).

This study also revealed institutional level (physical) barriers affecting BAME students’ PA engagement during the COVID-19 pandemic lockdowns, including government mandated restrictions on social movement and multiple guidelines. Additional individual physical barriers were identified including sickness, arthritis, injuries, and pregnancy. This is replicated in the findings of Farah et al. (2021) which suggested that factors such as laziness and fatigue, lack of motivation, pain, injury, and fear of injury affect PA participation. These were found to be exacerbated by the COVID-19 lockdowns and restrictions, leading to altered behaviours and attitudes. It could be argued that BAME students who lived a sedentary lifestyle before the COVID-19 lockdown simply worsened their attitude towards PA participation during it. Whilst pregnancy was identified by one participant as a barrier to physical activity during this time this highlights the need to consider the specific barriers and increased vulnerability felt by women during the COVID-19 pandemic. A factor that requires recognition and support in any future outbreaks.

Respiratory conditions such as asthma, was highlighted by several participants within this study as a major barrier to PA engagement, thus demonstrating the increased vulnerability of people with chronic conditions. This was enhanced through the heavily documented susceptibility of severe if not life-threatening symptoms if COVID-19 was contracted by people of any age with this condition (Gillissen & Paparoupa, 2015; Stoodley et al., 2019; Panagiotou et al., 2020).

This study revealed the impact of the strict government restrictions and standard operating procedures during the COVID-19 pandemic leading to the closure of gyms and recreation centres on BAME individuals. These align with those of Hailey et al. (2022) and Wright et al. (2022) who found the closing of gyms and recreation centres lowered the levels of PA participation among UK BAME individuals.

Based upon the findings of this research it is recommended that successful implementation of public health and social measures dependent on adequate resources, including medical equipment, personnel, and financial dealings from the UK government be considered in a timely manner to better safeguard against such impacts in any future outbreaks or pandemics.

In conclusion, the vital restrictions enforced to control the devastating effects of the COVID-19 pandemic had a profound and potentially long-term impact on PA participation among many BAME individuals. This research demonstrated that the perceptions and experiences of BAME students could be successfully mapped onto the COM-B domains, enabling a better understanding of the participants experiences to be garnered, and conclusions to be drawn. Physical activity participation was limited due to physical, social, institutional, and psychological barriers, the factors of which were complex and varied. This study is the first to modify the COM-B. During the transition into a new normal way of living, should any future periods of restrictions this modified COM-B model should be utilized as part of focused behaviour change interventions. Mapping the experiences and perceptions of BAME students on all the domains of the COM-B model was considered significant to facilitate an understanding PA participation as well as consideration of strategies to reduce sedentary behaviour. This is important if any future strategies to enhance PA engagement are to be implemented effectively.

This study was the first to explore physical activity perceptions and experiences of BAME Teesside University students during the COVID-19 pandemic. Capability to engage in PA and facilitators or barriers to PA were the two themes identified through the application of the modified COM-B model. This model can be used to implement physical activity BAME policies guiding future interventions aimed at modifying behaviour models to understand the specific barriers and facilitators for BAME individuals.

Author note

Dr. Johnson Mbabazi (University of Teesside), Fiona MacGregor (University of Teesside), Professor Jeff Breckon (Teesside University), Professor Barry Tolchard (Teesside University), Professor Edward Kunonga (Teesside University), Dr. Dorothy Irene Nalweyiso (Teesside University), Abiola Fashina (Teesside University), Dr Lawrence Achilles Nnyanzi (Teesside University)

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Johnson Mbabazi

Dr. Johnson Mbabazi is 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 a senior staff member of the Teesside University Health Student Research Network (TUHSRN).

Jeff Breckon

Prof. Jeff Breckon is an associate Dean for Research and Innovation in the School of Health and Life Sciences at Teesside University, mentor and Co-founder of TUHSRN.

Barry Tolchard

Prof. Barry Tolchard is the Director of Integrated Care Academy, mentor and a Co-founder of TUHSRN.

Edward Kunonga

Prof. Edward Kunonga is a public health consultant, lecturer, mentor and member of TUHSRN at Teesside University.

Dorothy Irene Nalweyiso

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

Abiola Fashina

Abiola Fashina is a Biomedical scientist and public health master’s student and an executive committee member of the TUHSRN.

Lawrence Achilles Nnyanzi

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

Appendix

Interview guide

Exploring Demographic Questions

1. How old are you?

2. What is your gender?

3. What is your sex orientation?

4. What council do you live in the Tees Valley?

5. Are you employed?

6. Are you a university student?

7. Are you still in education?

8. Do you have any health issues?

9. What is your marital status?

Questions Categorised Using Themes

COVID-19, Physical Activities (PA), Culture and Black Asian Ethnic Minority (BAME)

Exploring knowledge of participants about COVID-19

1. What do you understand by COVID-19?

2. Do think your family council handled covid-19 well?

3. Do think the university handled covid-19 well?

4. Do think your local council handled covid-19 well?

5. Is there something you would want your family to do about Covid19?

6. Is there something you would want the University to do about Covid19?

7. Is there something you would want your local council to do about Covid19?

8. Would you talk to your family about the issue surrounding covid19?

9. Do you think we must all be responsible for each other about the issue of covid19?

Exploring Experiences of participants about Physical Activities

(Acquire themes at the pre-contemplation and contemplation stages)

1. Have you recently considered beginning any physical activities? If so any reasons (pre-contemplation)?

2. Have you thought of doing any physical activities (contemplation)?

3. Can you briefly tell me how your physical activity participation has been in recent months. Any noticeable changes before, during and after lockdown including the type of physical activity you engaged in and how frequently you engaged in physical activity participation?

4. Has your motivation for performing physical activity changed?

   1. Reasons for performing physical activities before COVID19?

   2. Reasons for performing Physical activities during COVID19?

   3. Reasons for performing physical activities (facilitators) overall?

   4. Pre and during COVID19)?

Exploring Experiences of participants about Physical Activities who have lost motivation (COM-B Model)

1. Do you know what a COM-B model is?

2. Why have you seized in engaging in physical activity?

3. What would have prevented you from giving up on physical activities?

Exploring general perceptions and feelings of Physical Activities

1. How do you feel about doing physical activities at the moment?

2. What are some of the reasons to explain your feelings at the moment?

3. Do you find it easy to conduct a physical activity?

4. Do you find it easy to speak about your family on the importance of doing a physical activity?

5. Are you generally happy about yourself as far as the physical activity you are involved in?

6. Do you feel any changes about you and your health when you perform a physical activity?

7. How do you feel about your physical activity habits?

Exploring experiences after the feedback process

1. Are there feelings or worry among the family members for performing physical activities?

2. Are there feelings or worry among the family members for not performing physical activities?

3. Are there changes in your way of life due to performing a physical activity?

4. Are there changes in your way of life due to not performing a physical activity?

5. Who are the providers of help that you have consulted?

6. Which help would you recommend to others and why?

7. What next planned about your physical activity lifestyle?

Exploring cultural experiences of physical Activities of Physical Activities

1. Does your culture play a part in your choice of physical activity?

2. How would you describe the role your culture plays in the performance of physical activities?

3. What aspect(s) keep(s) you motivated to pursue physical activities?

4. Would you describe your level of motivation as high to continue with physical activities? If so, why?

5. Have physical activities benefited your mental wellbeing? Can you please explain how and why?

6. Can you describe any factors that you think have facilitated or hindered your participation in physical activity (how and why)?

7. Are there any behavioural or attitudinal changes towards physical activity that you have seen in yourself since you began residing in the United Kingdom? Which and why?

Feelings about lifestyles

1. Do you think performing physical activities can act as an important lifestyle for you?

2. Do you think performing physical activities can act as an important lifestyle for family?

3. Do you think it is important to feedback changes due to physical activities to your family?

4. Generally, what do you make of the whole process?