The Role of Socioeconomic Position in Adolescent Physical Activity
Background: There is strong evidence of health inequalities during and beyond adolescence and inequalities in the social determinants of health including physical activity. Unlike in children and adults, the impact of socioeconomic position (SEP) on physical activity behaviour during adolescence is unclear. Qualitative evidence aiming to understand this from the adolescent perspective is lacking, as are efforts to understand equitable approaches to physical activity promotion. Aim: Taking a mixed-methods approach, this thesis aims further our understanding of the role of SEP in adolescent physical activity and in the development of equitable physical activity promotion strategies. Project 1: First, I report on my systematic review of qualitative evidence to understand if adolescents' experiences of the barriers to and facilitators of physical activity differ by SEP. Synthesising 25 studies, the review shows that adolescents of a low-SEP experience more barriers to physical activity than those of middle- and high-SEP. These findings highlight adolescents of a low-SEP as a high-risk group, this is used to inform the approaches taken in the following project. Project 2: I then took a mixed-methods case study approach to evaluate whether socioeconomic inequalities arise during a school-based physical activity intervention. The findings of this project suggest school-based population level interventions have the potential to benefit students of a low-SEP, however differential engagement in the intervention and response to evaluation measures may have biased these conclusions. Throughout this project, I demonstrate a novel way of evaluating inequalities within young people’s physical activity interventions. Project 3: Given the promise of school-based physical activity interventions, I then planned to take a mixed-methods approach to evaluate the acceptability and feasibility of a targeted intervention applying Sport England’s satellite club model to the school setting. Unfortunately, this project could not be fully implemented due to the impact of the Covid-19 pandemic. The findings of an interim report, based on the initial stages of the intervention, highlight the potential for high-risk school-based approaches targeting young people in socioeconomically deprived contexts, providing direction for future research. Project 4: During the final project I took a qualitative approach to understand, from the perspective of adolescents living in socioeconomically deprived communities, whether the Covid-19 pandemic influenced their physical behaviour and their views on how we can help young people become more active moving forward. The findings further highlight socioeconomic inequalities in adolescent physical activity, which were exacerbated by the Covid-19 pandemic. Young people suggested implementing school-based physical activity interventions during the school day with a focus on fun and the structural environmental regeneration of socioeconomically deprived areas, to provide young people with safe and low-cost physical activity opportunities. Conclusions: This thesis highlights how young people living in the context of socioeconomic deprivation experience more barriers to physical activity when compared to other socioeconomic groups. Evidence for the potential of both population and high-risk school-based approaches in equitable physical activity promotion is presented, providing promising direction for the future of school-based intervention strategies. Adolescents’ experiences of the Covid-19 pandemic emphasise existent inequalities in physical activity and recommendations are made from the young person’s perspective for equitable physical activity promotion moving forward.
Adolescence, Physical Activity, Socioeconomic Position
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