1. business and industrial

The need for a physical education:
Examining physical activity during the transition to university
By
MATTHEW YIU WING KWAN,
B.A., M.Sc.
A thesis submitted in conformity with
the requirements for the degree of
Doctor of Philosophy
Graduate Department of Exercise Sciences
University of Toronto
© Copyright by Matthew Yiu Wing Kwan, 2011
Ph.D. Dissertation – M. Kwan
The need for a physical education: Examining physical activity during the transition to
university
Doctor of Philosophy, 2011
Matthew Y.W. Kwan, Department of Exercise Sciences, University of Toronto
Abstract
While physical activity (PA) declines across the lifespan, this does not occur
linearly. Declines are most pronounced during the transition into early adulthood. This
dissertation consisted of three studies examining PA decline during the transition into
early adulthood: (1) to understand patterns of PA and other health behaviours of
Canadians; (2) to understand reasons for PA declines during entry into university; and (3)
to examine the feasibility and effects of a website-delivered PA intervention.
Study 1 utilized multilevel modeling to identify patterns of PA, binge drinking
and smoking among a nationally-representative cohort of adolescents (N = 640). Results
found PA decline evident among all young adults transitioning into early adulthood
regardless of educational trajectory – declines being most pronounced among
college/university males – highlighting the saliency of PA decline, as other health
behaviours stabilized or declined during early adulthood.
Given justification for intervening with the university population, study 2
explored students’ perceptions of PA, and their preferences towards a PA intervention.
Eight focus groups were conducted with first-year university students (N = 45). Results
found students being concerned with PA decline, and were receptive to an Internet-based
intervention. However, such concerns are inflected with ambivalence, potentially posing
a challenge for interventionists.
ii
Ph.D. Dissertation – M. Kwan
Findings from studies 1 and 2 informed the development of a website-delivered
PA intervention – ‘Active Transition’. Pre-testing was conducted with first-year students
(N = 15) and PA experts (N = 7), which found the website and its content being
acceptable and usable. Results of the efficacy trial (N = 65) found Active Transition to
successfully attenuate declines in PA cognitions, and to some extent, PA behaviours. This
confirms the Internet being a useful tool for delivering PA interventions in this
population. However, given modest compliance in terms of usage, future work is required
to evaluate the addition of more current/popular strategies for engaging students.
Overall, this dissertation has provided justification for why it is critical that
research continues work with this population, and has provided the foundations in
helping with the long-term vision of implementing a population-level initiative to help
students attenuate the significant declines in their PA behaviours. iii
Ph.D. Dissertation – M. Kwan
DOCTOR OF PHILOSOPHY (2011)
University of Toronto
(Exercise Sciences)
Toronto, Ontario
TITLE:
The need for a physical education: Examining physical activity
during the transition to university
AUTHOR:
Matthew Yiu Wing Kwan, B.A. (University of Lethbridge), M.Sc.
(McMaster University)
SUPERVISOR:
Dr. Guy E.J. Faulkner
NUMBER OF PAGES: viii, 247
iv
Ph.D. Dissertation – M. Kwan
Acknowledgments
And I thought writing the dissertation was tough… I honestly do not know where
to begin with these acknowledgements… Reflecting back to all the years as a student,
particularly across post-secondary school, I have had so many memorable experiences.
In fact, I believe that my initial interest in working with the university-student population
probably stemmed from all of those positive experiences as an undergrad – which has
been a true blessing in disguise. Now that I have (in the eloquent words of my brother)
finally stopped pressing the snooze button on life, I feel that I am leaving school with so
much more than I initially bargained for. A lot of this is because I’ve always been in a
fortunate position, having great people in my life to guide me in the right direction…
First and foremost, I would like to thank my supervisor, Guy Faulkner. It is
difficult for me to articulate just how much I appreciate all the support and mentorship
you have provided me over the past three-plus years. I will always appreciate the fact
that you allowed me to take my ‘student-sabbatical’, as those life-experiences while
living and travelling abroad have been invaluable. Likewise, thank you for providing me
with the opportunities and resources enabling me to attend several international
conferences – most notably in Portugal! You are truly an outstanding scholar, and I’d
like to think that I have picked up a little of that wisdom. Everything from your ability as
a multi-dimensional researcher to your apt ability to network (i.e., bring key people
together), it is no wonder why you are one of the most respected figures in our field. I
am honoured and grateful to have worked under your supervision, and I look forward to
future collaborative work. I wish you nothing but continued success.
I will forever be indebted to my good friend and continued mentor, Steve Bray. I
don’t think I can ever thank you enough for taking me under your wings in Lethbridge,
and providing me with the opportunities that you did as a graduate student. In thinking
about everything from our bi-hourly coffees at the student union, to ‘borrowing’ those
mugs from Cheers in Boston, all the way to enjoying Dublin together, you have been one
constant spanning across my university career. We have accomplished a lot in terms of
our research together, and as we often say to one another, we’ll have this thing nailed
down in 10 or 20 years! So thank you for always being there for me Steve…
v
Ph.D. Dissertation – M. Kwan
I would also like to take this opportunity to say a special thanks to John Cairney.
I continue to marvel at all the achievements and accolades you have and continue to
receive, and I am truly grateful that you were a part of my PhD. Aside from that
intimidating CV of yours, I want you to know how much I have appreciated your
mentorship. Despite that continual busy schedule, it was unbelievable that you always
made time for me; whether it was to address a specific problem, or to chat about setting
up my future. Maybe the one exception was when sent me an apology for neglecting me,
only to proceed to neglect that follow-up. Of course, I’m only joking, and I am really
looking forward to working with you!
Working in an environment that fosters collaboration, there are a number of other
key people that have been influential during my PhD. Thanks to Larry Leith, Amy
Latimer, Nancy Gyurcsik, Kathleen Martin Ginis, as well as the EPU for all their support.
Most notably, I’d like to thank Paul, Fil, and Vanessa, who made my transition into the
lab much easier. A special thanks to Dr. Kelly Arbour-Nicitopoulos, who has been a
tremendous resource for me both at Mac and U of T. I would also like to acknowledge
the help from Eleanor Pullenaygum, Carmina Ng, Tanya Weedon, and Justin Fisher – all
of whom made my dissertation possible! Finally, thanks to my Bimbo’s (sport teams),
providing me with the all important work-life balance.
My final acknowledgement goes to Courtney, Mom, Dad, and Curtis. I am at a
loss for words when it comes to telling you how much you all mean to me. All of this
would have so much more difficult (if even possible) without your unconditional love
and support you have provided me. I’d like to think that this accomplishment is that
much more satisfying and meaningful because I get to experience it with each one of you.
I want you to know that I love you, and that I look forward to our continued successes in
the future for us to collectively share.
vi
Ph.D. Dissertation – M. Kwan
Table of Contents
SECTION
PAGE
TITLE PAGE
i
ABSTRACT
ii
DESCRIPTIVE NOTES
iv
ACKNOWLEDGEMENTS
v
CHAPTER 1
1.0 A Commentary: The Need for a Physical Education
1.1 Focusing on the Transition to University
4
1.2 The Caveats to Research
6
1.3 Opportunities for Research
7
CHAPTER 2
2.0 Review of Literature
2.1 General Patterns of Physical Activity
10
2.2 The Transition from High school to University
12
2.3 Factors Related to the Declines
14
2.4 Gaps and Limitations
20
2.5 Recognizing the Need for Action
26
2.6 Program of Study
27
CHAPTER 3
Patterns of Physical Activity and Other Health-Risk Behaviours during the
Transition to Early Adulthood: A Longitudinal Cohort Study of Canadians
Introduction
42
Methods
47
Results
53
Discussion
56
vii
Ph.D. Dissertation – M. Kwan
CHAPTER 4:
Informing to Intervene: A Formative Study to Understand Perceptions of
Physical Activity Decline and the Barriers to Physical Activity during the
Transition to University
Introduction
83
Methods
88
Results
97
Discussion
113
CHAPTER 5:
Active Transition: A Pilot Study of a Website-Delivered Physical Activity
Intervention for University students
Introduction
134
Pre-Testing
144
Efficacy Trial
147
Post-Intervention Evaluation
159
Discussion
162
CHAPTER 6:
General Discussion
6.0 Program of Study Contributions
193
6.1 Contributions to Advancing Research
193
6.1.1 Longitudinal examination of physical activity
and other health behaviours
194
6.1.2 Formative research
197
6.1.3 Making the active transition
199
202
6.2 Final Conclusion
STUDY APPEDICIES
A.1 Study I Materials
205
B.1 Study II Materials
211
C.1 Study III Materials
219
viii
Ph.D. Dissertation – M. Kwan
CHAPTER 1
A Commentary:
The Need for a Physical Education
1 Ph.D. Dissertation – M. Kwan
1.0 The Need for a Physical Education
Across the lifespan, children and youth are generally the most active segment in
the population, however, as this youth population moves toward adulthood, an
accelerated erosion in physical activity behaviour is evident (Caspersen, Pereira, &
Curran, 2000; Gordon Larsen, Nelson, & Popkin, 2004). This decline is not necessarily
linear, including some points in time where large declines in physical activity occur, as
well as points where general physical activity levels are sustained or increase slightly
(Curtis, White & McPherson, 2000). One particular time period seen to have the most
dramatic decline occurs during late adolescence and transition into young adulthood (e.g.,
Gordon-Larsen et al., 2004; Zick, Smith, Brown, Fan, & Kowaleski-Jones, 2007).
It should not be surprising that young adulthood marks the primary decline in
overall levels of physical activity, considering it is a period of increasing assimilation into
the adult work world. When students leave secondary school, they have a multitude of
options, such as entering the work world, seeking further education, joining the armed
forces, backpacking around the world, or doing something else. Regardless of the many
possible trajectories following high school, a significant proportion of young adults opt
for the route of higher education at post-secondary institutions. University and college
students are not an insignificant cohort. In 2004, the percentage of the 18 to 21 year old
population enrolled in postsecondary education was 29% in the UK, 32% in Canada, 42%
in the US, and as high as 62% in Korea (U.S. Department of Education, 2007).
A strong impetus exists for research to address physical activity declines in the
college/university student population (Sparling, Owen, Lambert, & Haskell, 2000).
2 Ph.D. Dissertation – M. Kwan
Evidence suggests that initiation of diseases such as atherosclerosis, obesity, and
diabetes, related to a lack of physical activity, may emerge as early as the second and
third decades of life (Leslie, Sparling, & Owen, 2001).
Although there are
inconsistencies in the literature, some evidence demonstrates that physical activity
patterns established during early adulthood appear to be a somewhat stable indicator of
physical activity behaviours during later adulthood. For example, Sparling and Snow
(2002) reported that most students who were regular exercisers (85% of them) during
their college senior years engaged in physical activity levels at similar or greater levels 6
years after their graduation. Conversely, those who had been non-exercisers (81% of
them) during their college years remained at their low levels of activity. Therefore,
because behavioural patterns may stabilize during early young-adulthood (e.g., while at
university), it is important to intervene at this stage and in this setting to prevent declines
in physical activity.
There is growing recognition that university and college students are an important
target population for health promotion efforts – some have even suggested that their
health is an 'important and neglected public health problem' (Wells, Barlow, & StewartBrown, 2003), and that the university or college is an appropriate ‘setting’ for the
delivery of health and physical activity promotion (see Gilson et al., 2009). Overall,
emerging work has focused on students in terms of physical activity during the transition
from high school to university or college and contend that beyond convenience, there is
strong justification for researching those close at hand – at least in terms of public health.
3 Ph.D. Dissertation – M. Kwan
1.1Focusing on the Transition into University
Declines in physical activity may be most prominent during the transition from
high school to the first year of university or college. Canadian tracking studies, based on
self-report measures and recall, consistently demonstrate steep declines in physical
activity behaviours during the transition into university. Bray and Born (2004) reported
that one third of their sample had been sufficiently active according to nationally
recommended (U.S. Department of Health and Human Services) standards during their
last year at high school but failed to meet those recommendations during their first year at
university. In terms of estimated energy expenditure (METs) being accrued through
physical activity, Bray (2007) found a 17% decline from high school first-year university.
More recently, Kwan, Bray and Martin Ginis (2009) examined average physical activity
frequency, and found students engaged in significantly more days of moderate or
vigorous physical activity for 30 minutes or more prior to entering university (3.5 days
per week), than they engaged in during their first semester at university (2.9 days per
week). Why do physical activity levels decline so markedly during this transition?
A transition period often involves drastic changes in the assumptions about
oneself and the world one lives in, requiring corresponding adjustments in behaviour and
relationships. The transition out of high school has been suggested to be the first major
life transition individuals make (Brooks, & Dubois, 1995), marking the movement from
late adolescence to young adulthood, and requiring numerous adjustments across several
life domains (Gall, Evans, & Bellerose, 2000). Given the new challenges that these
individuals face, it is not difficult to understand how a newly acquired independence is
4 Ph.D. Dissertation – M. Kwan
reflected through changes in behaviour. For example, previous inhibitions about a
variety of risk behaviours, such as smoking or drug use (and more speculatively, physical
inactivity), may weaken due to reductions in adult supervision and the perception that
many risk behaviors are considered adult behaviours (Colder et al., 2008).
In line with a developmental perspective on behaviour, the correlates and
determinants of physical activity may also vary across the lifespan. For example, there is
empirical evidence that indicates first-year students report significantly more physical
activity barriers, and of a different kind, than they faced during high school (Gyurcsik,
Bray, & Brittan, 2004; Gyurcsik, Spink, Bray, Chad, & Kwan, 2006). Many of those
entering college or university are also moving away from the stability of home for the
first time and adjusting to independent living (Lafreniere et al., 1997).
Kwan and
colleagues (2009) used the theory of planned behaviour (TPB) to examine students’
social cognitions regarding physical activity. Most of the students entering university had
high intentions of being physically active during their first-year. However, despite this
strong initial desire to be active, the findings indicated that translating those intentions
into behaviour proved difficult.
Ajzen and Fishbein (1980) have pointed out that the intention-behaviour
relationship tends to decline in strength as soon as people encounter difficulties. It may
be the transition itself in not knowing what to expect in a new environment and not
having the skills to maintain physically activity in this new setting that prevents young
adults from maintaining physical activity levels. Illustratively, Bray, Millen and Kwan
(2004) found that students who were living with their families had less disruptions in
5 Ph.D. Dissertation – M. Kwan
their physical activity patterns, and were less likely to become insufficiently active during
the transition compared to either students who lived on or off campus.
Interventions tailored to address these population-specific perturbations in social
(e.g., peer influence) and environmental (e.g., moving away from home) conditions are
just emerging. Bray and colleagues (2008) presented one of the first interventions that
focused on this population. They developed tailored first-year student physical activity
guides (pamphlets) that described strategies to overcoming common student-specific
barriers. In comparison to students who received either a standard guide to physical
activity or no guide, the results showed attenuation in the decline of physical activity for
students who received the first-year student guide.
Students receiving the first-year
guide engaged in greater weekly frequencies of moderate and vigorous physical activity
during their first semester.
1.2 Caveats to the Research
The university student population has always been an attractive population for
researchers; students are conveniently located, plentiful in supply, and in some cases,
available as research participants in return for course credit. The use of such a convenient
sample rightly leads to questions regarding the external validity of the research, and
possibly some disdain, among academic peers who nobly refrain from accessing such
easy targets for their studies. In an influential paper, Sears (1986) drew attention to the
overreliance on college students for social psychology research. For example, more
recent research has confirmed that college students are a more homogenous group than
non-students, are more open-minded, having stronger cognitive skills, and stronger
6 Ph.D. Dissertation – M. Kwan
tendencies to comply with authorities (Peterson, 2001). Of course, the sample chosen for
any research project depends on the research question—but in this case, scientists may
have developed ‘a portrait of human nature that describes rather accurately the behavior
of college students in an academic context but distorts human social behavior more
generally’ (Sears, 1986, p. 515).
There is also another important factor to consider: that education attainment is one
of the most consistent correlates of physical activity (e.g., Trost et al., 2002). At a
population level, student cohorts are more physically active than those who have a highschool education or less. However, they are not necessarily active ‘enough’; and the
declines remain a critical public health issue. Indeed Sparling and colleagues (2000)
suggested that university graduate students are likely to have a disproportionate influence
on the population's health through their future roles as policy makers, managers, and
professionals of the future because of their health-related lifestyles and their beliefs about
health shaped through their college years. This points to the need for longitudinal and
experimental research comparing alternative trajectories of young adults, and ultimately
adapting our developing conceptual model for attenuating declines in physical activity in
university students to those who take alternative vocational pathways.
1.3 Opportunities for Research
University and college students are a convenient sample, but there is compelling
evidence that there is an important public health issue here for physical activity
researchers to engage with and intervene on. This population represent a sizeable group
of young adults; physical activity levels appear to markedly decline during this time,
7 Ph.D. Dissertation – M. Kwan
particularly during the initial transition; there are unique challenges in making the
transition to higher education which points to the existence of life-stage specific
correlates or determinants of behaviour; and there is tentative evidence that these can be
modified through intervention and declines in physical activity curbed in the short-term.
The university or college setting should be considered a critical setting for health
promotion for many of the reasons that schools are (Fox & Harris, 2003). There is
potential for exposing university and college students to sustained health messaging
through already established knowledge exchange methods and messengers. There is
growing diversity in the ethnic and socioeconomic fabric of many universities. There are
subsidized physical activity facilities, programs and staffing commonly available. The
literature focusing on this population group is still relatively new, and there are many
opportunities for novel research in understanding this transitioning population and in
developing theoretically informed interventions to promote physical activity ranging
from intrapersonal approaches – for example, helping students to bridge the gap between
intentions and behaviour in the context of a new environment (Gollwitzer, 1999) to
environmental approaches – for example, making campuses more walkable (e.g., see
Sisson, McClain, & Tudor-Locke, 2008). The key point is that we can intervene!
8 Ph.D. Dissertation – M. Kwan
CHAPTER 2
Review of Literature
9 Ph.D. Dissertation – M. Kwan
2.1 General Patterns of Physical Activity
Given the convincing scientific evidence relating a lack of sufficient physical
activity to premature morbidity and mortality, physical activity promotion is critical for
public health. The unfortunate reality is that the majority of individuals are physically
inactive and this issue has become a global concern (Dishman, Washburn, & Heath,
2004; Kimm et al., 2005). It is estimated that 60% of adults (Centers for Disease Control
and Prevention [CDC], 1998) and 36% of youth in the United States do not engage in
sufficient levels of physical activity to achieve health benefits or an adequate fitness level
(Kahn et al., 1997).
Similarly, 51% of Canadian adults and Canadian youths are
considered to be inactive (Canadian Community Healthy Survey, 2005).
Temporal
trends show physical activity participation decreasing over time (Knuth & Hallal, 2009),
which corresponds to recent compelling data suggesting that Canadians are becoming
less fit and more rotund (Shields, Tremblay, Laviolette, Craig, Janssen, & Connor
Gorber, 2010; Tremblay, Katzmarzyk, & Wilms, 2002; Tremblay, Shields, Laviolette,
Craig, Janssen, & Connor Gorber, 2010).
Declining physical activity participation with age is a consistent finding within
the epidemiological literature (Dishman et al., 2004; Gordon-Larsen et al., 2004; Sallis,
2000). Although the evidence points to an inverse relationship between age and physical
activity, data also suggests that disproportionate changes in physical activity behaviours
occur as individuals move through their youth and adolescence, transitioning into young
adulthood (Dishman & Dunn, 1988; Kimm et al., 2005; Nelson, Gortmaker,
Subramamian, & Welchsler, 2007). Of the 49% of Canadian youths considered to be
10 Ph.D. Dissertation – M. Kwan
sufficiently active, cross-sectional analyses indicate that youth aged 12-14 were
significantly more active than 15-19 year olds (CCHS, 2005; CFLRI, 2002). However,
there have also been longitudinal studies confirming and extending those cross-sectional
findings. These longitudinal studies have found the rate of physical activity decline being
much greater during the adolescent years compared to during adulthood (Casperson et al.,
2000; Telama & Yang, 2000; Van Mechelen, Twisk, Post, Snel, & Kemper, 2000). In
particular, it does appear that the transitional time period between adolescence and young
adulthood is where the greatest decline occurs (Caspersen et al., 2000; Malina, 2001a, b;
Zick et al., 2007).
The abrupt change in physical activity participation that shows itself in other data
representing late adolescence to young adulthood is also evident among high school
graduates who enter university. Consistent with the results of larger epidemiological
tracking studies, Bray and Born (2004) found a steep decline in physical activity levels
during this transition period. Their findings indicated that one third of the student
population had been sufficiently active according to nationally recommended standards
(U.S. Department of Health and Human Services) during their last year at high school,
but failed to meet those recommendations during their first year at university. Several
additional studies provide further support, reinforcing the notion that drastic declines in
physical activity behaviours occur during the transition into university. For example,
Gyurcsik, Bray, and Brittain (2004) reported that 47% of first-year students failed to meet
the recommended level of weekly physical activity. This general decline presents itself
regardless of the type of self-report physical activity measurement used. For example,
11 Ph.D. Dissertation – M. Kwan
Kwan, Bray, and Martin Ginis (2009) examined average physical activity (moderate and
vigorous type activity) frequencies, and found students engaging in more days of
moderate or vigorous physical activity for 30 minutes or more prior to entering university
(3.5 days per week), than they engaged in during their first semester at university (2.9
days per week). In terms of estimated energy expenditure (METs) accrued through
leisure-time physical activity, Bray (2007) found a 17% decline in average METs being
expended during high school to that being expended during first-year university.
2.2 The Transition from High School to University
Schlossberg (1981) defines transition as an event or non-event resulting in a need
for adaptation to alter one’s perception to fit into a new situation. Moreover, it often
involves changes in the assumptions one makes about oneself and the world one lives in,
and often requires corresponding adjustments to behaviour and relationships.
The
transition from high school to university is a stressful time involving numerous aspects of
change for students (Gall et al., 2000; Lafreniere et al., 1997), particularly for those
moving away from their parents and home for the first time, as it would be the first time
they experience independence. As first-year students embark on their new phase in life,
one traditional view is that this transition is positive, offering exciting new opportunities.
However, because the transition is a momentous life change, represented by novel
challenges, many late adolescents and young adults experience difficulties adjusting to
university (Lafreniere, et al., 1997; Rutter, 1989).
These challenges are also evident within the context of physical activity. In fact,
there is empirical evidence that suggests the stresses of this particular transition may be
12 Ph.D. Dissertation – M. Kwan
associated with changes in a variety of behavioural cognitions and behavioural patterns,
including that of physical activity. For example, Gyurcsik, Spink, Bray, Chad, and Kwan
(2006) examined the physical activity barriers that students faced through adolescence
and during their transition into university. The results of that study found physical
activity barriers being twice as prevalent for students in university compared to students
in high school. Using semi-structured open-ended questions, first-year students identified
various interpersonal, intrapersonal, institutional and community barriers that they
perceived to have hindered their physical activity behaviours during their first-year at
university. Institutional and community barriers were most frequently cited, having to do
with school workload and the lack of transportation and community facilities.
The
interpersonal barriers were also salient; including the various temptations and invitations
to go out partying, the travel necessary to go back home to visit family and friends, and a
lack of familiarity with who to participate in activities with.
Maintaining physical activity during the transition is associated with a range of
health benefits.
Recent research has found a positive relationship between being
physically active and increased physical and psychological well-being in this student
population (Bray & Kwan, 2006; Kwan, Bray, & Gyurcsik, 2004). Kwan and colleagues
found that students who were insufficiently active were 3.9 times more likely to have
contracted a common cold, 2.6 times more likely to have had the flu, and showed
significantly higher levels of negative somatic symptoms in comparison to the students
who were sufficiently active. In a follow-up study, Bray and Kwan (2006) found inactive
students exhibited greater negative somatic symptoms, and were twice as likely to have
13 Ph.D. Dissertation – M. Kwan
visited a doctor for illness-related concerns, compared to students who were sufficiently
active. Therefore, understanding reasons behind the decline in physical activity during
first-year university has both short and long-term public health implications.
2.3 Factors Related to the Decline
Considering the many health implications that are associated with regular physical
activity during young adults’ transition into university, understanding the correlates and
determinants of physical activity is clearly necessary (Buckworth, 2000). Recently, a
number of theory-based studies have emerged, identifying some of the key determinants
of physical activity behaviour among students transitioning into university. Within the
current literature, two theoretical frameworks have been most commonly utilized.
Research has either been based on Bandura’s (1986) Self-Efficacy Theory, or Ajzen’s
(1985) Theory of Planned Behaviour. Overall, the theory-based research has provided
salient information around physical activity behaviours, and has significant implications
towards developing an intervention aiming to attenuate the decreases in physical activity
as students transition into university.
Self-efficacy is defined as the “beliefs in one’s capability to organize and execute
the courses of action required to produce given attainments” (Bandura, 1997, p. 3).
Beliefs about their efficacy are considered to be developed through performance
experiences, vicarious experiences, verbal persuasion, and physiological/emotional states
(Bandura, 1997).
Consistent with the broader self-efficacy literature, students’
confidence appears to be an important predictor of physical activity as they transition
from high school into university. There is empirical evidence to suggest that students’
14 Ph.D. Dissertation – M. Kwan
confidence to perform physical activity (i.e., task self-efficacy), and confidence to cope
with physical activity barriers (coping self-efficacy) are both robust predictors of physical
activity participation during their first-year at university.
Leighton and Swerssen (1995) reported the first study that examined various
correlates of physical activity behaviour among first-year university students, and found
exercise self-efficacy and perceived obstacles being the two strongest predictors of
students’ participation in vigorous physical activity. In subsequent investigations, there
has been a greater focus on the role of self-efficacy to cope with perceived obstacles.
Three studies have found coping self-efficacy to be a significant predictor of physical
activity behaviour (Bloomquist, et al., 2008; Bray, 2007; Gyurcsik et al., 2004). In a
study by Gyurcsik and colleagues (2004), coping self-efficacy was found to be a
significant predictor of first-year students’ vigorous physical activity mediated through
task self-efficacy.
As past behaviour is considered be a good indicator of future behaviours (Ajzen
& Fishbein, 2005; Bandura, 1997), Bray (2007) examined the relationship between
coping self-efficacy and previous and subsequent physical activity behaviours. Previous
physical activity behaviour explained 38% of the variance in subsequent physical activity
behaviour; however, this was reduced to 20% after controlling for coping self-efficacy.
These findings suggest that coping self-efficacy partially mediated the relationship
between past and subsequent behaviours, indicating that some form of interruption in
one’s habitual physical activity behaviours.
Overall, these findings highlight the
importance of first-year students’ task and coping self-efficacy for physical activity,
15 Ph.D. Dissertation – M. Kwan
suggesting that intervention efforts need to target students’ confidence to engage in
physical activity, and to cope with salient physical activity barriers.
In addition to self-efficacy theory, there has been some recent work applying
Ajzen’s (1991) Theory of Planned Behaviour (TPB) to predict first-year students’
physical activity behaviours. There is an abundance of support for the TPB predicting a
variety of health behaviours (Armitage & Conner, 2001; Godin & Kok, 1996), and it is
recognized as one of the most validated models applied to understanding why people
exercise (Courneya & Bobick, 2000). According to the theory, intention reflects one’s
motivation, and is the most proximal determinant of whether the behaviour will be
performed or not. The TPB states one’s intentions are developed through positive or
negative evaluations (attitudes), social acceptance (subjective norms), and one’s
perception of controllability and confidence (perceived behavioural control). Consistent
with the TPB, Kwan et al. (2009) found that students’ attitudes, subjective norms and
perceived behavioural control were significant predictors of their intentions to be
physically active, explaining between 37% and 44% of the variance. Also consistent
with the broader TPB literature, attitudes and perceived behavioural control were found
to be the strongest predictors of students’ intentions.
Contrary to the hypotheses,
however, the results did not find students’ intentions and perceived behavioural control
being significant predictors when entered into the full model predicting physical activity
behaviours. Given that the transition into university has been found to be associated with
constant change and an increase in physical activity barriers (e.g., Gyurcsik et al., 2006),
it may not be surprising that students’ initial intentions did not correspond with their
16 Ph.D. Dissertation – M. Kwan
subsequent behaviours. Ajzen and Fishbein (1980) suggest that an intention-behaviour
relationship tends to decline in strength as soon as people encounter difficulties. Such
may have been the case for first-year students when unanticipated demands of academic
and social life arose, displacing their earlier intentions to be physically active during their
first year. While this interpretation is consistent with the notion that first-year students
encounter significantly greater physical activity barriers during university than in high
school, it should be noted that less is understood about the context in to which students
transition, and how the demands of a variety of behavioural adaptations affect physical
activity cognitions and behaviours.
There has been other research utilizing the TPB constructs in an attempt to better
understand students’ physical activity cognitions and behaviours. For example, Kwan,
Bray, Woodgate and Gyurcsik (2007) conducted a comparison study of students’
attitudes, perceived behavioural control, intentions, and behaviour, based on one’s
consideration of future consequences (CFC). CFC is the degree to which one would
consider distant versus immediate consequences of a potential behaviour (Strathman,
Gleicher, Boninger, & Edwards, 1994). For example, individuals with high CFC tend to
have greater consideration of potential and future benefits or consequences afforded by
their current behaviours. As expected, Kwan and colleagues reported that first-year
university students with high CFC also scored greater on their attitudes towards physical
activity behaviour, perceived behavioural control, as well as their intentions to be
regularly active. Subsequently, the findings also showed that students’ CFC was a
significant predictor of physical activity behaviours, with those scoring higher in CFC
17 Ph.D. Dissertation – M. Kwan
being more active than students with low CFC.
Although consideration of future
consequences is considered to be a relatively stable trait, it has also been thought to be
amenable to change (Strathman et al., 1994). These findings may also have important
implications regarding the maintenance of physical activity behaviours. Rothman (2000)
suggests that a decision of behavioural maintenance involves a consideration of whether
the outcomes associated with the patterns of behaviour are sufficiently desirable to
warrant continued actions.
Thus, while perceived satisfaction with future outcomes
appears to be an important factor influencing students’ physical activity cognitions and
subsequent behaviours, efforts may also be needed to help students increase their
consideration of future consequences while also educating students on some of the
immediate benefits associated with physical activity.
In another examination of TPB constructs, Kwan and Bray (2008) conducted a
case-control study, comparing active and non-active students. Examining the data
retrospectively, the purpose of the study was to examine the differences in social
cognitions between the students who were subsequently active during their transition to
university, and those who had declined in their physical activity participation. In the
comparison of the TPB model predicting intentions, the results indicated that active
students demonstrated greater prediction in their intentions to be physically active,
accounting for 44% of the variance in comparison to 34% for students who were not
active. Perhaps more compelling, the findings also indicated that attitudes emerged as
the only significant predictor of active students’ intentions, highlighting the salient role
personal evaluation and outcome expectancies may play in predicting motivation for
18 Ph.D. Dissertation – M. Kwan
being physically active in this population. Similarly, Bloomquist and colleagues (2006)
conducted a comparison examination of self-efficacy on students with mis-matched
intentions and behaviour (large discrepancies in their intentions and their subsequent
behaviour) and matched intentions and behaviour (students who had little discrepancy in
their intentions and subsequent behaviours). As hypothesized, their findings showed the
students with matched intentions and behaviour to have greater exercise self-efficacy and
more confidence to cope with barriers to physical activity, in comparison to the students
with mis-matched intentions and behaviours.
Taken together, the current body of
literature offers significant theoretically-informed insight pertaining to first-year students’
physical activity cognitions and physical activity behaviours. Comprehensively, this
information will be critical in the development of intervention efforts aimed at
attenuating the declines in physical activity behaviours evident among the young adult
population transitioning from high school into university.
Considering that some of the factors influencing first-year students’ physical
activity behaviours are beginning to be identified, the next step is to introduce
intervention efforts specifically directed at population-specific determinants of physical
activity (Baranowski, Anderson, & Carmack, 1998; Baranowski, Cerin, & Baranowski,
2009). In an attempt to utilize some of the aforementioned empirical findings, a group of
researchers from McMaster University developed a physical activity guide, specifically
tailored for first-year students transitioning into university.
This first-year student
physical activity guide used a modified Canada’s physical activity guide. This brochure
draws from social cognitive theory and is intended to provide information such as
19 Ph.D. Dissertation – M. Kwan
exercise prescription, as well as strategies to facilitate self-perceptions and motivation to
be physically active (Bray et al., 2007). In addition to the informational content aimed at
increasing students’ confidence for making lifestyle adaptations, or outcome
expectations, the leaflet also includes an interactive action planning calendar.
To test the effectiveness of the leaflet as an intervention tool, Bray and colleagues
(2008) compared groups of students who received the tailored physical activity guide to
groups who either received a standard Canada’s Physical Activity Guide (CPAG) or no
guide (control group). The results from this intervention are promising, indicating that
the intervention (targeted physical activity guide) was effective in attenuating first-year
students’ physical activity decline compared to the conditions that received no guide or
the standard CPAG. Although the effects from the targeted intervention were modest,
students indicated that the first-year guide had more interesting content than the standard
CPAG, while perceiving the information to be highly credible. These results were
positive, considering that, to my knowledge, there have not been any intervention efforts
prior to this of Bray and his colleagues. The findings suggest that first-year university
students can benefit from interventions that specifically target physical activity
behaviours during the transition into university.
2.4 Gaps and Limitations
Focused research examining physical activity during the transition out of high
school is in its infancy. While there may be some consistencies between the reported
behavioural patterns among the epidemiological studies (e.g., Gordon-Larsen et al.,
2004), and studies specifically examining individuals transitioning into university (e.g.,
20 Ph.D. Dissertation – M. Kwan
Bray & Born, 2004), it is important to consider that attending college or university is only
one of many choices that young adults can pursue. There may be evidence to suggest
that transition-related declines in physical activity are prevalent for young adults who
enter college or university, however, behavioural patterns for young adults choosing an
alternative pathway following high school remain largely unknown. The exclusive focus
on physical activity among young adults transitioning into college or university may
provoke some criticism. These criticisms may be justifiable, considering post-secondary
education is often considered an important social determinant (Kean & Wolpin, 2001),
and that adult physical activity rates vary depending on educational attainment (US
Department of Health and Human Services [USDHHS], 2004). More specifically, data
from the USDHHS demonstrate that college educated individuals have the highest levels
of physical activity participation. In general, socio-economic status is an established
indicator of physical activity behaviours, with individuals from higher and lower income
households participating in more or less physical activity, respectively (Lox, Martin
Ginis, & Petruzelo, 2004; Van Der Horst, Paw, Twisk, & Van Mechelen, 2007). Given
that most of the young adults who choose to enter college or university come from
middle to upper class families (Baker & Velez, 1996), and are likely to have a parent that
obtained higher education (Kean & Wolpin, 2001), questions might be raised about the
legitimacy or importance of research on what is actually the most active segment of the
population. However, to the best of my knowledge, there has yet to be a longitudinal
study on physical activity comparing behavioural patterns based on academic
achievement. Without this point of comparison, only tentative conclusions can be drawn;
21 Ph.D. Dissertation – M. Kwan
therefore, it is unknown whether efforts are being appropriately utilized by focusing on
the young adults who make the transition into post-secondary education.
There are also a number of methodological issues evident in the review of
literature.
One issue stems from physical activity measurement.
Much of our
understanding behind the declines in physical activity levels during the transition from
high school to university relies on self-report physical activity tools administered only
after these individuals have entered university. For example, Kwan and colleagues
(2009) used a prospective study design that measured high school physical activity
behaviours when students first entered university (representing past physical activity
behaviours, prior to transition), and measured again after the students’ first two months at
university.
While it may be difficult to implement behavioural surveillance among
individuals prior to university (i.e., students moving around the country), it does suggest
that results from these prospective studies may need to be interpreted with caution. The
literature typically asks participants to recall their physical activity participation
anywhere from 2 to 8 months prior to entering university (e.g., Bray, 2007; Bray &
Kwan, 2006; Kwan et al., 2009). While a self-report measure of physical activity may
provide a fairly representative estimation of past behavioural patterns, an eight-month
period is a substantial amount of time, and this prolonged period of recall may lend itself
to increased measurement error and decreased accuracy (Fisher & Katz, 1999).
Another limitation with these studies relates to their relatively small sample sizes
(e.g., 200 participants), which typically consists of a convenience sample of first-year
students often from the same university. With these methodological concerns in mind,
22 Ph.D. Dissertation – M. Kwan
there are opportunities for researchers to further investigate physical activity patterns
among young adults who transition into university. For example, a longitudinal study
can be conducted and used to model physical activity from adolescence, across the
critical transition period, and followed through early adulthood. Such study design would
not only satisfy issues around consistency in measurement, but would lend itself to
examining individuals who transition into an alternative route following high school.
Therefore, beyond the understanding of the initial transition into university, this research
can address questions of whether this decline is a transient occurrence, or something that
is sustained through early adulthood.
In addition to physical activity, it is also valuable to examine patterns of other
health-risk behaviours during the transition from adolescence to early adulthood. This
would allow the possibility of comparing and contrasting changes in physical activity
with changes in other health behaviours.
Similar to issues of insufficient levels of
physical activity, other health behaviours such as cigarette smoking and excessive
drinking are considered a major public health concern among the young adult population
(CDC, 2002; Rigotti et al., 2000; Wechsler & Kuo, 2000). Given that the entry into early
adulthood is a period associated with increased independence, it is likely that inhibitions
tend to weaken as adult/parental influences become less assertive (Dierker et al., 2006);
and despite its detrimental consequences, these health-risk behaviours can be seen as
positive or socially acceptable/normative behaviours (Arbour-Nicotopoulos, Kwan,
Taman, Lowe, & Faulkner, In press; Colder et al., 2008; Rigotti, Lee, & Wechsler, 2000).
23 Ph.D. Dissertation – M. Kwan
The evidence suggests that smoking and binge drinking affect most college and
university campuses (LaBrie, Pedersen, Lamb, & Bove, 2006; Johnston, Bachman,
O’Malley, & Schulenberg, 2006; Rigotti et al., 2000). Approximately 70% of college
students reported alcohol use within the last month, including the majority reporting a
bout of binge drinking (> 5 drinks at one occasion) at least once in that previous month
(Wechsler, Lee, Nelson, & Kuo, 2002; O’Malley & Johnston, 2002), while nearly a
quarter of post-secondary students are either daily or occasional smokers (ACHA, 2008;
Cairney & Lawrance, 2002). Given that research has demonstrated the predictive values
of both smoking and drinking in mapping the initiation and escalation of one another
within the collegiate populations (Dierker et al., 2006; Duncan et al, 1998, Flay et al.,
1998, Jensen et al., 2003), an examination of how changes in these behaviours compare
to changes in physical activity is warranted. Although there is some evidence to suggest
that many individuals tend to ‘mature-out’ of smoking and/or binge drinking, it is
important to realize that a substantial proportion continue these risk behaviours beyond
early adulthood (Dierker et al., 2006). Therefore, a better understanding of smoking and
binge drinking patterns for young adults transitioning out of high school will offer a
substantial contribution not only towards future development of program initiatives and
policy change, but will also help contextualize declines in physical activity.
Another gap evident within the research literature is the lack of qualitative
exploration of whether this population is interested in receiving support to be physically
active, and what kinds of support are preferred. The literature primarily consists of
theory-based quantitative research, attempting to better understand the determinants of
24 Ph.D. Dissertation – M. Kwan
physical activity within this population. However, less emphasis has been placed on
understanding in-depth issues contributing to the declines in physical activity levels for
first-year university students. Gyurcsik and colleagues (2006) used open-ended semi
structured questions with participants asked to identify their physical activity barriers;
however, the barriers students identified were subsequently categorized and quantified
into barrier frequencies, thus limited conclusions could be drawn. Bray and colleagues
conducted a study qualitatively examining the issues around barriers and facilitators to
physical activity among first-year students; however, that work has yet to be published.
Qualitative research can provide critical understanding specific to a population in
question.
More specifically, this type of exploration uncovers population-specific
accounts of the social and behavioural environments in which these first-year university
students are situated. Particularly because this is a time of drastic change, a better
understanding of what those changes are, and how they relate to physical activity
participation is something that needs to be developed. In fact, it has been suggested that
detailed population-specific understanding needs to be obtained prior to any intervention
efforts, and that this lack of understanding has been one reason why many intervention
efforts have not obtained desirable levels of behaviour change (Baranowski et al., 1998;
Kahn et al., 2002). While the lack of contextual understanding is a major gap in the
literature, this may be related to another gap in the literature – the limited attempts to
intervene with first-year university students. The university or college campus has often
been suggested to be a critical setting for health promotion for many of the same reasons
why primary or secondary schools are (Fox & Harris, 2003). There is tremendous
25 Ph.D. Dissertation – M. Kwan
potential for exposing students within their institution to sustained health messages
through already established knowledge exchange methods and messengers. Despite these
opportunities, there has only been one attempt to intervene with the incoming freshman
population (Bray et al., 2007).
While this lone intervention was theoretically sound, it
was not clearly based on the needs and preferences of the target population.
For
example, results from a recent study indicate that despite being regarded as
believable/credible information, information within a leaflet is not a preferred method for
students to obtain health-related information (Kwan, Arbour, Lowe, Taman, & Faulkner,
2009). Although it may be difficult to speculate, the findings of Kwan and colleagues
suggest that Bray and colleagues’ intervention effects could have been more influential
had they delivered the brochure content on the Internet – the top source from which
university students obtain health-related information. Therefore, exploration of students’
intervention interests and preferences should be explored. Overall, it appears that future
research would benefit from population-specific understanding of students’ transition to
university, and qualitative research will be critical for informing the development of
interventions.
2.5 Recognizing the Need for Action
Despite the young adult population generally being considered the healthiest
cohort (WHO, 2008), rapid increases in obesity and obesity-related disorders such as type
II diabetes and hypertension emerging during early adulthood are alarming (Sparling,
2007). . Rarely is a lack of sufficient physical activity perceived as something requiring
immediate attention; thus, its urgency may often be underestimated within the young
26 Ph.D. Dissertation – M. Kwan
adult population (Sparling, 2003). Low physical activity is an important predictor of
weight status and obesity-related problems, and there is growing recognition among
college health professionals and researchers that increasing obesity is a major public
health concern (Gow, Trace, & Mazzeo, 2010; Lloyd-Richardson, Bailey, Fava, & Wing,
2009; Vella-Zarb, & Elgar, 2009) However, one might question the utility of studying
the young adult population transitioning into post-secondary school; where these
individuals are generally more privileged, are less at-risk for a variety of mortalities or
early morbidity, and tend to be more active later in life.
From a general public health
standpoint, however, irrespective of the path that is chosen following high school, it is
important to encourage physically active lifestyles to the entire population. Given that
the empirical evidence has consistently found significant declines in physical activity
among young adults transitioning into university, research efforts must attempt to
understand the reasons for its occurrence, and determine the best methods to attenuate
those deteriorations in physical activity participation.
2.6 Program of Study – Purpose
The general purpose of this dissertation was to develop a program of research that
provided a novel and substantial contribution to the research literature. Moreover, it was
also an objective to develop a challenging program of research to fully extend my skills
as a researcher. Subsequently, three independent studies were developed, conducted, and
are presented in the proceeding chapters. Each of the research questions were designed
to address limitations in the existing literature, with the broader aim of providing the
27 Ph.D. Dissertation – M. Kwan
foundations of a population-level physical activity intervention for students transitioning
into university.
While compelling evidence exists to suggest that transition-related declines in
physical activity are prevalent for young adults entering college/university, behavioural
patterns for young adults who choose non-academic pathways remain largely unknown.
Therefore, to acquire a better understanding of behavioural patterns during the transition
from adolescence to early adulthood, the purpose of the first study was to utilize the
National Population Health Survey (NPHS) to longitudinally (over 12 years) examine
physical activity behaviours among a nationally-representative cohort of 12-15 year olds.
The purpose of the second study was to use qualitative methodology (focus groups) to
explore students’ perceptions of physical activity, the salient barriers impacting their
physical activity behaviours, and their interests and preferences regarding potential
physical activity interventions. From the results of study 1 and study 2, a theoreticallyinformed website-delivered physical activity intervention named
‘Active Transition’
was developed. The purpose of the final study within the program of research was to
pilot Active Transition, specifically testing the acceptability, usability, feasibility, and
efficacy of the website-delivered intervention targeting students transitioning into
university.
28 Ph.D. Dissertation – M. Kwan
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40 Ph.D. Dissertation – M. Kwan
CHAPTER 3
Patterns of Physical Activity and Other Health Risk
Behaviours during the Transition to Early Adulthood: A
Longitudinal Cohort Study of Canadians
41 Ph.D. Dissertation – M. Kwan
Patterns of physical activity and other health risk behaviours during the transition
into early adulthood: A longitudinal cohort study of Canadians
Physical Activity Behaviours
There is unequivocal evidence that physical activity is strongly and causally
associated with health (Barnett, Gauvin, Craig, & Katzmarzyk, 2008; Center for Disease
Control, 1998). Based on population-attributable risk estimates, approximately 20% of
premature mortality could be prevented through regular engagement in physical activity
(Katzmarzyk, Glenhill, & Shephard, 2000). This is particularly concerning given that the
majority of the Western world does not accrue the necessary amount of activity as
nationally recommended (Craig, Russell, Cameron, & Beaulieu, 2001; Dishman et al.,
2004; Kimm et al., 2005). In the United States, it is estimated that 60% of adults and
36% of youth do not engage in sufficient levels of physical activity to achieve health
benefits or an adequate fitness level (Centers for Disease Control and Prevention [CDC],
1998; Kahn et al., 1997).
Likewise, about half of Canadian adults and youths are
considered to be inactive (Canadian Community Healthy Survey [CCHS], 2005).
Physical activity behaviour is multifaceted, including a complex interaction of
transitional, social and economic factors (Brownson, Boehmer, & Luke, 2005).
Variations in physical activity patterns are evident across certain groups of individuals;
and socio-economic status and gender are well-established determinants of physical
activity participation (Dishman et al., 2004; Lox, Marin Ginis, & Petruzzello, 2004).
Data from the United States Department of Health and Human Services (USDHHS,
2004) show adults with lower levels of educational attainment (one indicator of socioeconomic status) having the lowest levels of physical activity engagement and the highest
42 Ph.D. Dissertation – M. Kwan
levels of physical inactivity. Conversely, college educated individuals were the most
active segment of the population with the lowest rates of physical inactivity. There is
also considerable evidence to suggest that males are more active than females across the
life course. For example, behavioural surveillance data in Canada indicates that a higher
proportion of males engage in sufficient levels of physical activity compared to females
(Canadian Fitness and Lifestyle Research Institute [CFLRI], 2002). Although a lack of
sufficient physical activity is a population-wide health problem, it has been suggested
that a concerted effort is required to develop interventions aimed at specific life stages
(King, 1994; Sparling et al., 2000). More recently, a strong impetus exists for research to
target the young adult population (Leslie, Sparling, & Owen, 2002; Sparling et al., 2000).
Despite the younger population being considered the most active segment of the
population, the transition into early adulthood has been identified as a period during
which dramatic declines in physical activity occur. Over the life course, physical activity
levels are highest during adolescence, but begin to erode as the youth population moves
toward later adolescence and into early adulthood (i.e., 15-19 years of age) (Caspersen et
al., 2000; Gordon-Larsen, Nelson & Popkin, 2004). Similar declines in physical activity
during the transition into young adulthood are evident in both cross-sectional (e.g.,
Casperson et al., 2000; Craig, et al., 2004) and longitudinal population-level research
(e.g., Gordon-Larsen et al., 2004; Telama et al., 2005; Telama & Yang, 2000). More
recently, a number of studies have found similar trends among young adults that
transition into college or university. More specifically, some studies have highlighted the
significant declines in physical activity behaviours occurring during the transition from
43 Ph.D. Dissertation – M. Kwan
high school into college or university. Consistent with the epidemiological evidence,
these studies have found physical activity participation to be significantly greater during
the last year at high school in comparison to the first year at post-secondary school (Bray
& Born, 2004; Bray & Kwan, 2006; Kwan, Bray, & Martin Ginis, 2009).
High school graduation is considered to be the first major transition that an
individual faces (Brooks & Dubois, 1995). It represents a complex process in which
youth that have been dependent on parental support, begin to take definitive steps
towards independence (Jekielek & Brown, 2005).
While there is a clear need for
intervention efforts targeting the young adult population, several outstanding issues
should be addressed to strengthen our understanding of health behaviours of the Canadian
young adult population.
For example, physical activity participation rates among
Canadians have been largely based on cross-sectional data (e.g., CCHS, 2005; CFLRI,
1999) or longitudinal data examined cross-sectionally (Allison, Adlaf, Ialomiteanu, &
Rehm, 1999). Longitudinal designs involve data being repeatedly gathered from the
same individual over time; however, much of research examining adolescents during the
transition into young adulthood has come from other countries such as the United States,
Netherlands and Finland (Gordon-Larsen et al., 2004; Telama et al., 2005; Telama &
Yang, 2000; Van Mechelen et al., 2000). These studies demonstrated clear gender
differences in physical activity levels but did not examine differences on the basis of
educational trajectory. While there have been several prospective studies examining
changes in physical activity behaviours during the transition into early adulthood (Bray &
Born, 2004; Bray & Kwan, 2006), they have generally been small studies comprised of
44 Ph.D. Dissertation – M. Kwan
convenient samples of college or university studies without any long-term follow-up.
Furthermore, despite consistencies between the population-level data and these small
studies, there has been no examination of physical activity patterns among young adults
that do not enter college or university. Given the aforementioned relationship between
physical activity and educational attainment – and without data to suggest otherwise –
questions could be raised about research with the collegiate population and its relative
importance in comparison to young adults that do not enter post-secondary schools.
Overall, there is a need for a longitudinal study to accurately describe physical activity
among Canadians as they transition from adolescence to early adulthood; and how
physical activity varies on the basis of gender and educational trajectory.
Physical activity decline and changes in other health behaviours
Health promotion strategies focusing on the prevention of smoking and problem
drinking have often overshadowed the need to emphasize other health behaviours like
physical activity (Sparling, 2007).
Similar to physical activity, these health-risk
behaviours are considered to be among the most modifiable causes of mortality such as
cardiovascular diseases, liver diseases and some forms of cancers (Poortinga, 2006).
However, despite elevating risk of premature morbidity and mortality, epidemiological
evidence suggests that the prevalence of smoking and binge drinking rapidly increases as
the adolescent population moves towards early adulthood (Poortinga, 2007; Schuit, van
Loon, Tujhuis, & Ocke, 2002; Wechsler, & Kuo, 2000).
Smoking and binge drinking behaviours among the late adolescent/young adult
population has garnered a lot of research attention (CDC, 2002; Rigotti, Lee, &
45 Ph.D. Dissertation – M. Kwan
Wechsler, 2000; Wechsler & Kuo, 2000). While smoking initiation tends to begin prior
to early adulthood, Rigotti and colleagues (2000) suggest that the collegiate years is a
critical time period when many students begin to experiment with smoking. Likewise,
entry into college/university also appears to lend itself to problem drinking, affecting
almost all post-secondary campuses (LaBrie, Pedersen, Lamb, & Bove, 2006). Nearly
70% of college students reported alcohol use within the last month (Johnston, Bachman,
O’Malley, & Schulenberg, 2006), and a vast majority of those students reporting at least
one session of binge drinking (defined as 5 or more drinks in single occasion) during that
time (Wechsler, Lee, Nelson, & Kuo, 2002; O’Malley & Johnston, 2002).
Similar to the physical activity literature, however, much of the understanding of
smoking and binge drinking among the young adult population is generalized to
individuals entering college or university. Cigarette smoking and problem drinking are
also two health behaviours that are associated with social markers such as educational
attainment (Greaves, Vallone, & Velicer, 2006; House, 2002; McCaffery, Papandonatos,
Lyons, Koenen, Tsuang & Niaura, 2007); therefore, it would also be beneficial to
investigate the patterns of these health-risk behaviours among Canadians transitioning
into college or university and those who do not. Overall, to extend the line of inquiry to
public health policy and practice, a greater understanding of these health-risk behaviours
are needed to develop theoretically and empirically based health promotion strategies. In
addition to establishing Canadians’ behaviours patterns of smoking and binge drinking, it
will also help in contextualizing the declines in physical activity behaviours. Comparing
and contrasting changes in physical activity with other more established health-risk
46 Ph.D. Dissertation – M. Kwan
behaviours would provide some insight as to the relative priority of intervention efforts at
the population level.
Study Purpose
To summarize, the primary purpose of this study was to examine the patterns of
physical activity during Canadians’ transition from adolescence into early adulthood.
Using a nationally-representative sample of Canadians, this study aimed to longitudinally
examine physical activity behaviours across a 12-year period, comparing behavioural
patterns based on gender and educational trajectories. That is, comparisons of Canadians
were made between males and females that transitioned into college or university
following high school graduation to those who did not. The current study also examined
the behavioural patterns of binge drinking and smoking among Canadians during their
transition from adolescence into early adulthood.
Methods
Background and Study Sample
The current study used data from seven cycles of Statistic Canada’s National
Population Health Survey (NPHS). Developed to collect information on the Canadian
population, the NPHS consisted of a multistage stratified cluster design targeting
household residents, similar to the sampling frame used for the Labour Force Survey
(Statistics Canada, 2006).
Approximately 19,600 households in all provinces were
chosen, with the exception of people living on First Nations Reserves or military bases,
or institutions or some remote areas in Northern Ontario and Quebec. The householdlevel response rate was 88%, and a total of 17,276 individuals participated in the first
47 Ph.D. Dissertation – M. Kwan
cycle of the NPHS. The longitudinal design has interviews being conducted with
participants on a bi-annual basis that began at cycle 1 (1994-1995), and up to cycle 7
(2006-2007; the latest cycle released by Statistics Canada).
The total sample size
decreased due to attrition caused by non-response (e.g., refusal, individuals untraceable);
however, Statistics Canada estimates indicate that the attrition should not lead to
substantial increases in the variance of estimates. To ensure that the data represents an
unbiased estimate, adjusted weightings are incorporated into the longitudinal survey at
each of the data collection points. A full description of the survey design and other
methodological issues is available elsewhere (Statistics Canada, 2006).
Using a longitudinal cohort design, 683 respondents were initially identified as an
adolescent cohort (between the ages of 12 and 15 during the first cycle in 1994-1995),
and could be examined prospectively (these individuals would be between 24 to 27 years
of age during the latest cycle in 2006-2007). Participant data, however, was only retained
for individuals who participated in a minimum of 3 of the 7 NPHS cycles, and a listwise
deletion was used if they completed fewer than 3 cycles. Three cycles (minimum) were
used to obtain parsimony within each of the models and reduce errors in estimation. No
significant differences emerged in any of the comparison of baseline demographic
characteristics between retainers and non-retainers (p’s <.05); however, the total sample
used for the study was reduced from the 683 to 640. Participant demographics of the
retainers are presented in Table 1.
48 Ph.D. Dissertation – M. Kwan
Measures
Physical Activity: Leisure-time physical activity was measured by estimating total
energy expenditure. At each wave, respondents were asked whether they had participated
in 20 listed activities (e.g., walking, bicycling, ice hockey) or other activities not listed
over the previous 3 months, and the typical length of time spent on each. The total time
spent participating in each activity and estimated relative intensity of each activity were
calculated by Statistics Canada to determine the MET scores (metabolic equivalent; 1
MET is resting energy expenditure; 3.5ml O2*kg-1*min-1; so 4 METs is equivalent to 4
times the resting rate). Conservative estimates of activity energy expenditures, MET
values were assigned to each of the leisure-time physical activities, as activity intensities
were not assessed and survey respondents have been shown to overestimate intensity,
frequency, and duration of exercise (Craig & Cameron, 2003); and has been found to
have acceptable test-retest reliability and criterion validity (Craig, Russell, & Cameron,
2002) Composite MET scores were subsequently divided and converted to reflect daily
energy expenditure. For more details on the measure of the physical activity measure
used, see Appendix A.1.
Binge Drinking: A single item was used in the examination of binge drinking. A
question asked “How often in the past 12 months have you had 5 or more drinks on one
occasion?” Respondents answered the question on a scale from 1 to 6, represented by 1
(never), 2 (less than once a month), 3 (once a month), 4 (2-3 times a month), 5 (once a
week), and 6 (more than once a week). The consumption of 5 or more drinks in a single
occasion has commonly been used to characterize heavy episodic binge drinking in the
49 Ph.D. Dissertation – M. Kwan
research literature (e.g., LaBrie, et al., 2006; Wechsler & Kuo, 2000). For more details
on the measure used for drinking behaviours, see Appendix A.2.
Smoking:
A single item was used to characterize smoking behaviours. The
question asks: “At the present time do you smoke cigarettes daily, occasionally or not at
all?”
Smoking behaviour was subsequently dichotomized to represent cigarette
“smokers” (respondents that indicated that they were either daily smokers or occasional
smokers), or “non-smokers” (respondents that indicated not at all). For more details on
the measure used for drinking behaviours, see Appendix A.3.
Educational Trajectory: A variable was created to reflect Canadians’ educational
trajectory in their transition into early adulthood. Two questions were used to distinguish
whether or not respondents had entered post-secondary school following high school
graduation. The first question asked respondents about their highest educational
attainment. Using this variable to establish the point at which respondents graduated
from high school, a subsequent question that asked about current education status was
used to ascertain whether participants had entered college/university or if they engaged in
alternative activities (e.g., participant in the labour force, unemployed). Respondents
who did not complete high school were also categorized as not transitioning into postsecondary school. In a small number of cases, there were non-responses and missing
data. Each case required independent examination to determine: a) whether they had
graduated from high school (i.e., if they graduated from high school during cycles 2 to 4);
and b) if they had proceeded to attend a post-secondary school following their graduation.
50 Ph.D. Dissertation – M. Kwan
Several demographic variables were also included in the
Demographics:
analyses. Gender was used as an independent variable for the comparisons between
males and females. Baseline household income and province were also entered into the
models as covariates.
Household income was included to account for confounding
factors associated with educational trajectory and socio-economic status. Household
income was stratified to reflect 3 (highest income), 2 (middle income), 1 (low income) or
were incomplete/missing.
Statistics Canada (2006) indicates that there are inter-
provincial differences in physical activity engagement across the country; therefore, to
account for any geographic discrepancies in physical activity behaviours, baseline
province was included as a control variable to provide more accurate estimates.
However, to make the models more parsimonious, provinces were categorized into the
Eastern, Central, or Western Regions of Canada. Further information concerning the
specific measures used in the NPHS can be found in the background documents
(Statistics Canada, 1995; Statistics Canada, 2006).
Statistical Analyses
Mixed effects modeling was used to examine physical activity and binge drinking
estimating change within individuals over time, adjusting for correlation within and
between subjects (repeated measures). These analyses included random intercepts at the
within-person level, and random slope for time. Generalized estimating equations (GEE)
were used to estimate changes in smoking behaviour within an individual over time, also
adjusting for within-subject variation. A repeated statement was included that had a
random slope for time. Both analytical approaches are considered to be appropriate for
51 Ph.D. Dissertation – M. Kwan
longitudinal data analyses, allowing for simultaneous examination of the effects of grouplevel and individual level variables on individual-level outcomes (Diez-Roux, 2000).
Using the model with the best fit, as suggested by Snijders and Boskers (1999),
unstructured covariance matrixes were used in the analyses of physical activity and binge
drinking, and independent covariance matrixes were used for the smoking analyses.
Each dependent variable (health behaviour) was included in multivariate analyses
with two models being specified. The first model starts by examining health behaviour
change over time, and potential gender differences. Household income and province
were also included in Model 1 as covariates; and to identify differences between males
and females in their behavioural patterns, a time by gender interaction was also included.
Educational trajectory was entered into the second model (Model 2). The effect of
educational trajectory and its appropriate two-way interactions were examined by adding
several interaction terms (time by educational trajectory, gender by educational
trajectory, time by gender by educational trajectory). In addition to examining gender
differences in health behaviour change over time, Model 2 is used to test whether these
changes are constant over time for males and females that did or did not transition into
post-secondary school following high school graduation. This procedure accounts for the
possibility that the effect of the educational trajectory may not be the same between
genders across time. All analyses were conducted using SAS version 9.2.
52 Ph.D. Dissertation – M. Kwan
Results
Physical Activity
Table 2 presents the first model showing the effect of time and gender on selfreported physical activity.
There were significant main effects for both gender
(coefficient= 1.791, SE= .22, t= 8.05, p< .01), and time (coefficient = -0.105, SE= .03, t=
-3.43, p< .01), suggesting that males were more active than females, and that physical
activity declined over time for both males and females.
The results also found a
significant time by gender interaction (coefficient = -0.170, SE= .04, t= -3.98, p< .01),
indicating that the rate at which physical activity declined over time was not the same for
males and females. When educational trajectory was added into model 2, estimates for
time and gender were significant, but the main effect for educational trajectory was not.
The results did show a significant time by educational trajectory interaction (coefficient =
0.134, SE= .06, t= 2.20, p < .05), while the time by gender interaction became nonsignificant (coefficient = -0.081, SE= .06, t= -1.41, p > .05). Most importantly, however,
was the emergence of a significant three-way time by gender by educational trajectory
interaction (coefficient = -0.189, SE= .09, t= -2.19, p< .05).
To facilitate greater interpretation of this result, the association between time and
physical activity for both males and females that did and did not transition into postsecondary school was graphed (see Figure 1). Physical activity behaviours among males
were generally higher across the transition into young adulthood, but this difference was
particularly evident during the adolescent years. Among males and females that did not
transition into post-secondary school, their decreases in physical activity participation
53 Ph.D. Dissertation – M. Kwan
were consistent over time.
However, patterns of physical activity were markedly
different between males and females who made the transition into post-secondary.
Interestingly, the most dramatic decreases in physical activity participation occurred
among males that transitioned into post-secondary school. Conversely, females that had
transitioned into post-secondary school following high school demonstrated the greatest
stability in their physical activity over time. Although post-secondary females were less
active during adolescence, the results show the convergence of physical activity
behaviours in the latter stages of early adulthood. Overall, physical activity decline was
evident among the general Canadian population as they transition from adolescence into
early adulthood; and although females were less active, post-secondary males were the
most susceptible to the steepest declines in physical activity during the transition into
early adulthood.
Binge Drinking
Similar to the physical activity results, model 1 for binge drinking found
significant main effects for gender (coefficient = -0.342, SE= .16, t= -2.09, p< .05), time
(coefficient = 1.162, SE= .07, t= 17.87, p< .01), and also a gender by time interaction
(coefficient = 0.299, SE= .09, t= 3.31, p< .01). In these models, a non-linear component
for time was also entered to account for the possibility that individuals could ‘mature out’
of health-risk behaviours; in other words, the effect of time on binge drinking may not be
strictly linear, owing to the fact that binge drinking may increase more rapidly in
adolescence but may decline in early adulthood (Dierker et al., 2006). Results including
the quadratic term for time were significant (coefficient = -0.114, SE= .01, t= -13.95, p<
54 Ph.D. Dissertation – M. Kwan
.01), but the time2 by gender interaction was not (coefficient = -0.016, SE= .01, t= -1.41,
p> .05), suggesting that there were no differences in the curvilinear patterns of binge
dinking between males and females during the transition from adolescence into early
adulthood.
There were few changes to the estimates when educational trajectory and its
interaction terms were entered into model 2 (see Table 3). Although the main effect for
gender, and the time by gender interaction became non-significant, main effects for time
and time2 remained significant. Given that results for gender and educational trajectory
were all non-significant, it appears binge drinking among Canadians did not differ on the
basis of gender or educational trajectory. However, as shown in Figure 2, a significant
time2 suggests that there were significant increases in the prevalence of binge drinking as
Canadians transitioned from adolescence to early adulthood.
Smoking
The results of the smoking analyses are shown in Table 4. Within model 1, only
time emerged as statistically significant (coefficient = 2.017, SE= .42, Z = 4.71, p< .01).
Again however, non-linear components for time were also entered into the models to
account for the possibility that individuals may ‘mature out’ of their patterns of smoking.
The results shows that both the quadratic (coefficient = -0.428, SE= .12, Z= -3.64, p<
.01), and cubic terms for time were significant (coefficient = 0.028, SE= .01, Z= -2.90, p<
.01). Similar to binge drinking, the results in model 2 for smoking show little change in
the estimates with the inclusion of educational trajectory and its interaction terms.
Overall, the results indicate that there are curvilinear patterns of smoking behaviours in
55 Ph.D. Dissertation – M. Kwan
Canadians as they transition from adolescence into early adulthood; but they were not
different on the basis of gender or educational trajectory. To facilitate the interpretation
of the smoking results, estimates were transformed into probability terms, and illustrated
in Figure 3. Smoking steadily increases during adolescence, but begins to plateau or
decrease slightly as individuals enter into early adulthood.
Discussion
To my knowledge, this is the first prospective cohort study to examine multiple
health risk behaviours as Canadian transition from adolescence into early adulthood. In
addition to examining potential differences in behavioural patterns between males and
females, this study also accounted for differences based on educational trajectory
following high school. Generally, it appears that the transition into early adulthood
represents a period in which drastic changes in health behaviours occur.
More
specifically, the results of the study confirm that there were decreases in physical activity
behaviours and increases in smoking and binge drinking behaviours as Canadians’
approached early adulthood. While patterns of physical activity continued to erode,
results indicate a reversal in smoking and binge drinking behaviours following their
initial transition into early adulthood.
Physical Activity
Consistent with the broader epidemiological evidence (e.g., Casperson et al., 2000
Gordon-Larsen et al., 2004; Telama & Yang, 2000), physical activity behaviours of
Canadians significantly decreased over a 12-year period as they transition from
56 Ph.D. Dissertation – M. Kwan
adolescence into young adulthood. As expected, the results of the current study found
males were more active than females. Interestingly, the greatest discrepancies in physical
activity between males and females were evident during adolescence, similar to the
CFLRI (2005) results. The findings suggest that despite the long recognized issue of
gender differences in physical activity, health promotion efforts have not been successful
in reducing the gap between males and females during their youth. Physical education,
or lack thereof, may be one reason for the large gap in participation. Recent data
suggests male students are receiving more physical education, including having greater
participation during gym class than female students (Wu, Rose, & Bancroft, 2007). It
appears that physical education curricula need to be re-examined and perhaps re-tooled to
promote a greater range of gender-appropriate activities. Physical education programs
have typically been modeled after male-dominated sports (Chepyator-Thomson and
Ennis, 1997; Williams, Bedward, & Penney, 2002), and despite recent attempts made to
provide gender inclusive physical education, the traditional, male-based, multi-activity
curricula are still dominant (Kirk, MacDonald, & O’Sullivan, 2006).
Despite the noticeable differences in physical activity participation between males
and females early in adolescence, at first glance, the results do indicate that the gender
gap begins to narrow as Canadians move toward young adulthood. Consistent with
national data from Scotland (Nove, 1997), a convergence of physical activity patterns
among males and females appears during the latter measurement cycles.
In the
comparison of genders and their educational trajectories, however, different patterns of
behaviours emerged.
More specifically, the results show a significant three-way
57 Ph.D. Dissertation – M. Kwan
interaction.
Upon closer examination, physical activity levels among the non-
college/university cohort declined at a similar rate over the 12-year period. However,
there were obvious differences in physical activity patterns among males and females that
transitioned into post-secondary school.
The results found post-secondary males
exhibiting the steepest declines in physical activity behaviours over the course of the 12year span, while post-secondary females showing only slight decreases in their overall
physical activity levels. Therefore, the convergence in physical activity was particularly
clear among the young adults that transitioned into college or university.
As evident in the three-way interaction, behavioural patterns differed on the basis
of gender and educational trajectory over the 12-year period. Although males proceeding
to post-secondary schools following high school exhibited the greatest decreases in
physical activity, the results also found significant erosions in physical activity among the
non-college/university Canadians – particularly among the female cohort.
This is
alarming given that non-college/university females were less active than males to begin
with (i.e., during adolescence), yet continued to decline throughout early adulthood.
While a re-tooled physical education program needs place a greater emphasis on
sustaining lifestyle physical activities, workplace interventions may be necessary.
Workplace interventions are becoming increasingly popular (Dugdill et al., 2008); as a
number of studies have been successful in helping employees increase their physical
activity behaviours (e.g., Chan, Ryan, & Tudor-Locke, 2004; Proper, Hildebrandt,
Vanderbeek, Twisk, & Van, 2003; Thomas & Williams, 2006). Given that many young
adults not entering post-secondary school will be joining the workforce, employers may
58 Ph.D. Dissertation – M. Kwan
be a critical agent for the implementation of initiatives aimed at attenuating declines in
physical activity among the non-college/university cohort.
Despite exhibiting only modest declines in their physical activity over time, it is
important to keep in mind that females that entered post-secondary school also
participated in less physical activity than males during their adolescence. Speculatively,
these findings might suggest that post-secondary school is a protective factor against
substantial declines in leisure-time physical activity. Future research should attempt to
understand how adaptations within this cohort were made, to determine how physical
activity could be better maintained among other segments of the population. This may
particularly relevant among males that transition into college or university, as
intervention efforts appear most critical as they demonstrate the most precipitous declines
in physical activity.
This highlights the need for campus-based interventions that
continue to be tailored on the basis of gender.
Comparisons with other health behaviours
As expected, rates of smoking and binge drinking increased over the course of
adolescence as the population reached 18 or 19 – the legal age at which Canadians are
permitted to purchase tobacco and alcohol. However, unlike physical activity, there were
curvilinear patterns to binge drinking and smoking behaviours. This is consistent with
the ‘maturing-out’ hypothesis (Dierker et al., 2006), which posits that health-risk
behaviours tend to decrease as a result of the increases in adult responsibility. The results
found a bell-shaped curve in the patterns of binge drinking, steadily increasing during the
adolescent years, peaking between the ages of 18 to 23, before steadily decreasing in the
59 Ph.D. Dissertation – M. Kwan
subsequent years. Similarly, there were steady increases in smoking behaviours during
the adolescent years, peaking during late adolescence/early adulthood (16 to 21 years of
age). Unlike binge drinking behaviours, however, the prevalence of smoking did not
steadily decrease, but instead began to stabilize. Interestingly, the results of the current
study found patterns of smoking and binge drinking being consistent regardless of gender
or educational trajectory. Overall, these findings indicate that the curvilinear patterns of
smoking and binge drinking occur invariably across each segment of the population, and
that strategies aimed at the prevention of both these health-risk behaviour are necessary.
Increases in smoking and binge drinking during the transition into early adulthood
is consistent with the notion that previous inhibitions may weaken following high school
graduation due to reductions in adult influence, and that the perceptions of these risk
behaviours may become more socially acceptable/normative (Colder et al., 2008).
However, unlike physical activity behaviours, the results of the study indicate that young
adults generally mature out of binge drinking and smoking behaviours.
Without
question, the consequences associated with binge drinking and smoking are troublesome.
While a controlled consumption of alcohol may not be associated with health-risks, the
consequences of binge drinking can include unplanned or unwanted sex, legal issues,
violence (both as a victim and assailant), and in the extreme cases, even death (Wechsler
et al., 2002).
In experimentation with smoking, the problem is that many become
susceptible to nicotine dependence (Rigotti et al., 2000). However, the results of the
study suggest that decreases in physical activity may be being overlooked in comparison
to smoking and binge drinking. While the prevalence of binge drinking and smoking
60 Ph.D. Dissertation – M. Kwan
stabilizes or declines during early adulthood, physical activity declines continued on a
downward trajectory. Overall, it appears that the transition out of high school represents
a window in which a substantial proportion of the general population become at high risk
for a multitude of health-risk behaviours. Clearly, intervention efforts at the populationlevel are needed to target the prevention of binge drinking and smoking behaviours
during the transition into early adulthood, but health promotion strategies must begin to
place a greater emphasis on physical activity decline.
Study Limitations
There are some limitations of this study. First, despite population level data being
used for analyses, they were based on self-report. Subsequently, it relied on participant
recall, which could have led to memory errors, and issues associated with social
desirability.
For example, there is evidence to suggest that respondents tend to
overestimate their participation in physical activity behaviours, and tend to underestimate
their engagement in other health-risk behaviours such as binge drinking and smoking
(Adams, et al., 2005; Frier, Bell, & Ellickson, 1991; Midanik, 1988). Another limitation
relates to the specific measures that were used for analyses. In terms of physical activity,
the purpose of this study was to examine changes in leisure-time physical activity
(LTPA), and excluded other activities contributing to daily energy expenditures (e.g.,
active transportation, workplace activities). Future work with other measures of physical
activity (e.g., accelerometers) would be valuable, providing more accurate behavioural
estimates within the population, while accounting for the various forms of activities
beyond LTPA.
In terms of smoking behaviour, smoking was dichotomized to
61 Ph.D. Dissertation – M. Kwan
characterize smokers (daily or occasional) and non-smokers; but as a result, daily and
occasional smoking behaviours are considered to be the same behaviours. This may
result in lost information and reduced power of the statistical test (Streiner, 2002).
Therefore, future research may need to examine daily and occasional smoking behaviours
independently, to determine whether any differences in the patterns of behaviours exist.
Despite some of the limitations of the study, there are several strengths of the study worth
mentioning. For one, this was the first known longitudinal examination of physical
activity and other health risk behaviours among Canadians transitioning from
adolescence to early adulthood.
Longitudinal designs provide the most accurate
estimates in long-term changes, partitioning out potential aging and cohort effects that
can hinder cross-sectional studies (Yee & Niemeier, 1996). Additionally, this study
assessed behavioural change among a nationally-representative sample of Canadians,
using multi-level statistics to further decrease potential errors in the estimates.
Summary
Overall, the transition into early adulthood marks a critical passage in one’s life,
and the pronounced changes in health behaviours may be reflected in the adaptations
required in both the social environment and newly acquired role responsibilities. In line
with previous suggestions that the transition out of high school is associated with
increased cancer risks (Bananowski et al., 1997), the current study found decreases in
physical activity and increases in binge drinking and smoking behaviours during
Canadians’ transition into early adulthood. However, the findings also indicate that
young adults tend to mature out of binge drinking and smoking behaviours, while
62 Ph.D. Dissertation – M. Kwan
physical activity continued to declines. While differences in physical activity patterns
emerged based on gender and educational trajectories, it appears that binge drinking and
smoking behaviours were consistent among the broader Canadian population. Given the
public health implications, efforts must be taken to prevent the occurrence of these
health-risk behaviours, particularly in physical activity decline, as Canadian adolescents
make their transition into early adulthood.
63 Ph.D. Dissertation – M. Kwan
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71 Ph.D. Dissertation – M. Kwan
Table 1
Demographic Characteristics of Nationally Representative Sample (N= 640).
Transition into PS
Did not Transition into PS
(n= 276)
(n= 364)
Male
114
218
Females
162
146
12
73
103
13
63
92
14
82
103
15
58
66
East
30
36
Central
174
209
West
72
119
High
163
168
Middle
22
40
Low
10
19
Income Missing
81
137
Demographic Variable
Gender
Age
Province
Household Income
Note: Values based on weighted longitudinal estimates. Provinces are represented by
regions of East (Newfoundland, Prince Edward Island, Nova Scotia, New Brunswick);
Central (Quebec, Ontario); and West (Manitoba, Saskatchewan, Alberta, British
Columbia). PS = post-secondary school.
72 Ph.D. Dissertation – M. Kwan
Table 2
Mixed-effects model predicting physical activity behaviours during Canadians’ transition
from adolescence into early adulthood.
Model 1
Model 2
Estimate
SE
Estimate
SE
Intercept
3.105***
0.512
3.337***
0.529
Time (cycle)
-0.105***
0.031
-0.172***
0.043
1.791***
0.222
1.703***
0.298
Gender
Male
Female
Gender by Time
-
-
-0.170***
0.043
-0.081
0.057
East
-0.080
0.202
-0.061
0.202
Central
-0.256
0.187
-0.265
0.187
Province
West
-
-
Household Income
Not Stated
-0.373
0.498
-0.491
0.500
High
-0.107
0.493
-0.231
0.495
Middle
-0.331
0.540
-0.418
0.540
Low
-
-
Educational Trajectory
Post-Secondary
-0.246
Non Post-Secondary
0.321
-
Time by Post-Secondary
0.134*
73 0.061
Ph.D. Dissertation – M. Kwan
Post-Secondary by Male
0.148
0.454
Time by Male by Post-Secondary
-0.189*
0.086
Note: *p <.05; **p <.01; ***p <.001. Provinces are represented by regions of East
(Newfoundland, Prince Edward Island, Nova Scotia, New Brunswick); Central (Quebec,
Ontario); and West (Manitoba, Saskatchewan, Alberta, British Columbia).
74 Ph.D. Dissertation – M. Kwan
Table 3
Mixed-effects model predicting binge drinking behaviours during Canadians’ transition
from adolescence into early adulthood.
Model 1
Model 2
Estimate
SE
Estimate
SE
Intercept
-1.070***
0.244
-1.031***
0.268
Time (cycle)
1.162***
0.065
1.188***
0.092
-0.343*
0.164
-0.248
0.219
Gender
Male
Female
-
-
Time2
-0.114***
0.008
-0.121***
0.012
Time by Male
0.299***
0.090
0.215
0.121
Time2 by Gender
-0.016
0.011
-0.003
0.015
East
0.038
0.092
0.040
0.092
Central
0.018
0.085
0.019
0.085
Province
West
-
-
Household Income
Not Stated
0.286
0.220
0.276
0.222
High
0.244
0.218
0.236
0.220
Middle
0.128
0.239
0.121
0.241
Low
-
-
Educational Trajectory
Post-Secondary
-0.066
75 0.237
Ph.D. Dissertation – M. Kwan
Not Post-Secondary
-
Time by Post-Secondary
-0.050
0.130
Post-Secondary by Male
-0.287
0.335
Time2 by Post-Secondary
0.014
0.016
Time by Male by Post-Secondary
0.211
0.184
Time2 by Male by Post-Secondary
-0.030
0.023
Note: *p <.05; **p <.01; ***p <.001. Provinces are represented by regions of East
(Newfoundland, Prince Edward Island, Nova Scotia, New Brunswick); Central (Quebec,
Ontario); and West (Manitoba, Saskatchewan, Alberta, British Columbia). PS = postsecondary school.
76 Ph.D. Dissertation – M. Kwan
Table 4
Generalized estimating equations predicting smoking behaviours during Canadians’
transition from adolescence to early adulthood.
Model 1
Model 2
Estimate
SE
Estimate
SE
Intercept
-3.667***
0.501
-3.738***
0.567
Time (cycle)
2.017***
0.428
2.248***
0.405
-1.075
0.700
-0.962
0.602
Gender
Male
Female
-
-
Time by Male
0.365
0.641
0.153
0.539
Time2
-0.428***
0.118
-0.487***
0.113
Time2 by Male
-0.045
0.173
0.001
0.150
Time3
0.028**
0.010
0.033***
0.009
Time3 by Male
0.003
0.014
-0.001
0.013
East
0.174
0.098
0.228
0.158
Central
0.324*
0.091
0.397**
0.147
Province
West
-
-
Household Income
Not Stated
0.203
0.218
0.350
0.366
High
-0.337
0.214
-0.119
0.362
Middle
0.572*
0.232
0.724
0.390
Low
-
77 -
Ph.D. Dissertation – M. Kwan
Educational Trajectory
Post-Secondary
-0.880
Not Post-Secondary
0.652
-
Time by Post-Secondary
0.005
0.592
Post-Secondary by Male
0.014
0.031
Time by Male by Post-Secondary
-0.185
0.438
Time2 by Post-Secondary
-0.001
0.167
Time2 by Male by Post-Secondary
0.118
0.166
Time3 by Post-Secondary
-0.001
0.014
Time3 by Male by Post-Secondary
-0.011
0.016
Note: *p <.05; **p <.01; ***p <.001. Provinces are represented by regions of East
(Newfoundland, Prince Edward Island, Nova Scotia, New Brunswick); Central (Quebec,
Ontario); and West (Manitoba, Saskatchewan, Alberta, British Columbia). PS = postsecondary school.
78 Ph.D. Dissertation – M. Kwan
Figure 1
Predicted physical activity scores in males and females that transitioned into postsecondary school or into an alternative activity.
5.5
5
4.5
4
METs
PS Males
3.5
Non‐PS Males
3
PS Females
Non‐PS Females
2.5
2
1
2
3
4
5
6
7
Time
Note: METs = estimated energy expenditure through leisure-time physical activity; TIME =
represents cycles of the NPHS beginning in 1994/1995 to 2006/2007; PS = post-secondary
school.
79 Ph.D. Dissertation – M. Kwan
Figure 2
Predicted scores on binge drinking in males and females.
4
3.5
3
Sessions
of binge 2.5
drinking
Binge (M)
Binge (F)
2
1.5
1
1
2
3
4
5
6
7
Time
Note: TIME = represents cycles of the NPHS
beginning in 1994/1995 to 2006/2007; Binge (M)
= sessions of binge drinking among males; Binge (F) = sessions of binge drinking among
females.
80 Ph.D. Dissertation – M. Kwan
Figure 3
Predicted probabilities of smoking behaviour of males and females.
1
0.9
0.8
0.7
Probability 0.6
of smoking
0.5
Smoke P (M)
Smoke P (F)
0.4
0.3
0.2
0.1
0
1
2
3
4
5
6
7
Time
Note: TIME = represents cycles of the NPHS beginning in 1994/1995 to 2006/2007; Smoking P
(M) = smoking probability among males; Smoking P (F) = smoking probability among females.
81 Ph.D. Dissertation – M. Kwan
CHAPTER 4
Informing to Intervene: A formative Study to Understand
Perceptions of Physical Activity Decline and the
Barriers to Physical Activity During the Transition to
University
82 Ph.D. Dissertation – M. Kwan
Informing to Intervene: A formative Study to Understand Perceptions of Physical
Activity Decline and the Barriers to Physical Activity during the Transition to University
Impetus for Physical Activity Intervention
Considering the many physical and psychological health implications associated
with regular physical activity (Dishman, Washburn, & Health, 2004; Bray & Kwan,
2006), research must continue to uncover ways to encourage people to be more active.
Targeting periods in the life course in which drastic declines in physical activity levels
occur should be a part of an overall public health strategy (cf. Baranowski et al., 1997).
One particular timeframe receiving greater attention is during the transition from late
adolescence to young adulthood. Recently, a number of studies have identified the
transition from high school to first-year college or university to be associated with
significant declines in physical activity participation. For example, Bray and Born (2004)
completed one of the first studies examining this transitional period, and found half of the
student population that had been sufficiently active during their last year at high school
had become insufficiently active during their first year at post-secondary school.
Additional studies have continued to demonstrate significant declines occurring in the
number of days students participated in moderate to vigorous type physical activity, and
in terms of estimated energy expenditure accrued through leisure time physical activity
(e.g., Bray, 2007, Kwan, Bray, & Martin Ginis, 2009). Given that decreases in physical
activity are particularly prominent during this transitional period, intervention efforts are
clearly necessary to attenuate such declines.
83 Ph.D. Dissertation – M. Kwan
Theory-based Research
Theory-based research has begun to uncover some of the population-specific
determinants of physical activity behaviours for young adults transitioning into first-year
university.
Overall, evidence suggests that students actually enter university highly
motivated, with a strong desire to lead physically active lifestyles (Kwan et al., 2009).
These intentions to be physically active are indicative of positive evaluations of being
physically active (i.e., understanding that it is good for them), and perceptions that they
are in control of their behaviours (i.e., feeling confident that they can be active
throughout their first semester). Despite the good motives students had as they first
entered university, however, the majority of students did not follow-through with their
earlier intentions, becoming less active than they previously were (Kwan et al., 2009).
One reason why there may be a discrepancy between first-year students’ intentions and
behaviours may be because they were overly ambitious or confident in their ability to
cope with physical activity barriers. The transition out of high school represents a
stressful time that involves numerous aspects of change for students entering university
(Gall, Evan & Bellerose, 2000; Lafreniere Ledgerwood, & Docherty, 1997); and in fact,
represents the first major transition that an individual has to make (Brooks & Dubois,
1995). Therefore, while students may perceive themselves to be in control of their
behaviours when they first enter university, it is likely that these perceptions of control
could change as they start to encounter some difficulties that may not have been
anticipated.
84 Ph.D. Dissertation – M. Kwan
Physical activity barriers have been a consistent predictor of physical activity
behaviours (Sallis & Owen, 1999), and appear to have important implications for students
transitioning from high school to university. Anecdotally, there are numerous changes
that accompany the transition from the stability of secondary school to larger and
potentially more impersonal post-secondary institutions. Empirically, there is evidence to
suggest that students encounter more barriers during their first year at university
compared to during their final year at high school (Gyurcsik et al., 2006). These findings
highlight the multiple changes and adjustments required as students enter this new
environment, perhaps capturing their inability to cope with new physical activity barriers.
Confidence in one’s ability to overcome common barriers, or coping self-efficacy, has
been a consistent predictor of physical activity behaviours (Bandura, 1997); and is
evident within the first-year student population. Two recent studies found students with
higher coping self-efficacy also engaging in more physical activity behaviour (Bray,
2007; Gyurcsik et al., 2004). Overall, the findings show coping self-efficacy to be a
robust predictor of physical activity, acting as a mediator between high school physical
activity and physical activity during students’ first-year at university.
Gaps in the Literature
Existing research addressing the declines in physical activity in this population
has been exclusively quantitative in nature. Little work has been done attempting to
understand physical activity during the transition into university; therefore, only limited
conclusions can be drawn in terms of our understanding of students’ perceptions of
physical activity, and the student-specific barriers that these young adults encounter. For
85 Ph.D. Dissertation – M. Kwan
example, although there is research to suggest that students have positive attitudes
towards physical activity (Kwan et al., 2009), it is unclear how students’ attitudes about
physical activity changes (if at all) over the course of their first year at university, and
whether declining physical activity is of concern to students.
In terms of physical activity barriers, Gyurcsik and colleagues (2006) investigated
barriers among first-year university students using open-ended semi structured questions.
However, because this methodology requires participants to list a number of barriers
within a longer questionnaire, participant burden could be a limiting factor in its
comprehensiveness.
In addition, the semi-structured questions also provide limited
information, thus issues such as the saliency of the barriers could not be discerned.
Given the relationship between physical activity-related barriers (including students’
ability to cope with these barriers) and physical activity behaviours, qualitative work is
clearly necessary to provide important knowledge pertaining to students’ physical activity
during the transition from high school into university.
This lack of understanding may be a contributing factor to the limited attempts at
intervening with first-year university students. To this point, Bray and colleagues (2008)
has been the only intervention study to specifically target physical activity among the
first-year student population. Using a tailored physical activity guide they developed, the
results of the study showed some modest attenuation in students’ physical activity
decline.
More specifically, compared to students who received either the standard
Canada’s physical activity guide or no guide (i.e., control group), students who received
the tailored guide exhibited less of a drop in their physical activity participation. In
86 Ph.D. Dissertation – M. Kwan
addition to the limited intervention attempts, a lack of understanding has also been a
reason why physical activity interventions in general have not demonstrated desirable
levels of change (Baranowski et al., 1998; Kahn et al., 2002). Although the findings from
Bray and colleagues (2008) were positive, results from a recent study found that
information delivered through a leaflet was not the preferred method for students to
obtain health-related information (Kwan, Arbour, Lowe, Taman, & Faulkner, 2010).
While it may be difficult to speculate, this suggests that Bray and colleagues’ (2008)
intervention effects could have been more influential had they delivered the content
within the brochure via the Internet – which was the top source from which university
students sought health-related information as reported by Kwan and colleagues. The
issue of intervention delivery is interesting. Despite the Internet being identified as the
most common source students for students to got health-related information, little is
known about what physical activity-related information students would want and how
that physical activity-related information should be delivered.
Therefore, while a
qualitative investigation around the perceptions of physical activity and physical activity
barriers appears warranted, it may also be beneficial to have an in-depth understanding
around students’ preferences towards the development of a physical activity intervention.
Study Purposes
Overall, there is compelling evidence to suggest that the transition into university
is associated with drastic declines in physical activity behaviours. In an effort to help
inform the development of future intervention efforts, the overall purpose of this study
was to utilize qualitative methodologies to build a comprehensive picture of how physical
87 Ph.D. Dissertation – M. Kwan
activity relates to the transitional experiences during students’ first year at university. By
utilizing qualitative methodologies, the current study included three specific purposes.
The first purpose was to gain a better understanding of students’ perceptions of physical
activity, and its role during first-year university. The second purpose of the study was to
identify the salient barriers that first-year students encounter during their transition into
university, gathering the in-depth reasons for their declines in their physical activity
behaviours. Lastly, in an effort to inform future intervention development, the third
purpose of this study was to ascertain preferences that students have with respects to a
prospective physical activity intervention.
Methods
Introduction and Overview
Given its ability to refine theoretical constructs, qualitative methodologies have
been recommended as a helpful stimulus for informing intervention development
(Baranowski et al., 1998; Creswell, Hanson, Clark & Morales, 2007). Work of this
nature, particularly in exercise psychology, has been increasing in popularity because
there is greater recognition of the need to understand personal experiences (Biddle,
Markland, Gilbourne, Chatzisarantis, & Sparks, 2001). Qualitative data often include
personal accounts, representing rich and in depth insight towards the way people
perceive, create and interpret their surroundings (Kreuger & Casey, 2000), which will be
helpful in addressing the complex issue of understanding why dramatic declines in
physical activity occur as young adults transition from high school into university. Focus
groups have become increasingly common within health research, specifically because it
88 Ph.D. Dissertation – M. Kwan
can be utilized for exploratory or hypothesis generation, or for explanatory purposes
(Wilkinson, 1998). Guided by a moderator, an advantage of focus groups is that it
enables a researcher to enter into another person’s perspective, while also gathering
information through the social interactions that are created among participants (Kreuger
& Casey, 2000; Patton, 2002). The dynamics of the group setting not only enables each
individual to share personal ideas and experiences, but also allows other members of the
group to build on them. For example, if other members of the focus group share similar
experiences, these participants are likely to be in agreement, and can expand on a shared
idea. Conversely, if one member experienced something different, he/she may challenge
and/or disagree with other’s thoughts, which may result in new emergent ideas. These
manifestations of ideas are something that individual interviews cannot achieve
(Litoselliti, 2003), thus focus groups were chosen for this study.
Research Sample
A total of 8 focus group interviews were conducted with 45 first-year university
students (Females = 26, Males = 19). The sample was drawn from a large university
campus in Canada during the spring of 2009.
Demographic information of the
participants is shown in Table 1. Eligible participants had to satisfy a number of criteria,
including: (1) being a first-year university student directly entering university from high
school; (2) reported having declined in their physical activity levels during the transition
from high school and into university; and (3) willing to share their thoughts and
experiences. Students that declined in their physical activity during their first year at
university represent the majority of students transitioning into university, and were
89 Ph.D. Dissertation – M. Kwan
chosen because they represent the target of the planned intervention.
Although
qualitative research has no uniform rules associated with choosing a sample size (Patton,
2002), typical focus group range between 4 and 12 individuals (Litoselliti, 2003). With
the exception of one focus group that had 3 participants, each of the focus groups met the
aim of having 5 to 8 participants. This focus group size provided a balance between
participants’ ability to share personal input and insight, as well as having opportunity to
interact, discuss, and challenge emergent ideas from other focus group participants. The
focus group sessions were approximately 70 to 80 minutes in duration.
The eight focus group interviews conducted were consistent with other focus
group research investigating issues on physical activity (e.g., Dwyer et al., 2006;
Whitehead & Biddle, 2008). Of the eight total focus groups, four focus groups were
conducted with students who lived on-campus (residence), while the remaining four
focus groups included the students who lived off-campus (commuters).
While
participants were all first-year students who transitioned directly from high school to
university, stratification based on residence was for made for two reasons. The first
reason was to increase group homogeneity, fostering greater comfort levels among
participants. This comfort level often enables a moderator to extract the most meaningful
information (Kreuger, 1994). Secondly, because students living on-campus and those
living off-campus may encounter different transitional experiences (e.g., Bray, Millen, &
Kwan, 2004), stratification provided the flexibility to make comparisons between these
cohorts. The total number of interviews within qualitative research depends largely on
data saturation, the point to which the researcher no longer begins to hear or see any new
90 Ph.D. Dissertation – M. Kwan
information (Kreuger & Casey, 2000). Although data saturation was reached prior to the
sixth focus group conducted, the focus group interviews were completed because they
had already been organized, and the latter groups were used to confirm that data
saturation was obtained.
Overview of Information Needed
The topics of discussion were primarily derived from the gaps in the current
knowledge identified in the review of literature. Since the focus groups were designed to
be exploratory by nature, a semi-structured interview schedule with general questions and
subject areas were used to guide the focus group and fulfill the three overarching
purposes of this study.
Each will be discussed below, but the complete interview
schedule can be found in Appendix B.1.
Perceptions of Physical Activity Decline
The first segment of the interview schedule explored perceptions of physical
activity during their first year at university. This section attempted to ease participants
into the focus group, having students provide their general thoughts and perceptions of
physical activity. For example, questions included “how did physical activity fit into
your first-year university experience?” and “Was the decline in physical activity
behaviours a concern to you?” Overall, the aim was to obtain the general interest level
students have regarding physical activity, and perceptual information towards a
prospective physical activity intervention.
91 Ph.D. Dissertation – M. Kwan
Physical Activity Barriers during First-year University
The second segment focused on the physical activity barriers students
encountered during their first year at university. Students were asked general questions
about why they had been more active in high school compared to university, and asked
students to identify specific barriers to physical activity (Sallis & Owen, 1999).
Specifically, students were prompted to consider barriers on the basis of an ecological
framework, identifying the intrapersonal, interpersonal, community/environmental, and
societal barriers.
Strategies towards Intervention
The final segment was developed to elicit general thoughts and ideas for a future
program (intervention) aimed at attenuating the declines in physical activity behaviours
for first-year students. Participants were asked questions relating to their preferences of
intervention delivery, and about the content that they would want within an intervention.
For example, students were asked: “Can you share some ideas with me about how you
would envision a program or intervention that may useful?”, “what should be included in
an intervention program?”, and “how can we get other students like yourself to engage in
an intervention?”
Piloting the Focus Group
A pilot focus group was conducted to determine whether any modifications in the
focus group schedule were necessary. This pilot was conducted on a convenient sample,
drawn from a first-year physical education course. The purpose of pilot testing is to
consider the nature of the questioning and characteristics of the audience (Kreuger &
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Casey, 2000). In other words, the pilot test determined whether the interview had logical
and sequential flow, and whether the participants were answering in the manner to which
the questions were designed for. Specifically, the moderator assessed whether they were
required to consistently prompt answers from the participants, which can have
implications for researcher bias. Additionally, a qualitative expert was elicited to act as a
note taker, to provide objective and impartial feedback regarding the focus group
schedule and process. Overall, the moderator, expert, and pilot focus group participants
agreed that the focus group schedule was appropriate, and that no major changes were
necessary.
Data Collection Methods
Participants were primarily recruited through flyers and advertisements (see
Appendix B.2).
Flyers and posters were distributed across the university campus,
containing a brief description of the study. Students who responded to the advertisements
were first screened to ensure that they met the study’s selection criteria, and then
subsequently assigned to a focus group. All participants received an e-mail confirming
their focus group participation, as well as an e-mail reminder the day prior to their
scheduled meeting.
Each focus group began with a briefing session, including an explanation around
the purpose and rationale of the study, and the ethics and confidentiality protocol. Prior
to the start of the focus group interview, participants were asked to provide signed
consent (Appendix B.3), and to complete a brief demographic questionnaire (Appendix
B.4). Primarily used for reporting purposes, the demographic questionnaire includes
93 Ph.D. Dissertation – M. Kwan
questions regarding age, sex, place of residence, and self-report measures of their
physical activity behaviours (see Table 1). The inclusion of the physical activity measure
was used as a manipulation check, to ensure that the focus group participants had indeed
declined in their physical activity behaviours at university. Following the completion of
the focus group interview, participants were de-briefed and received $10 compensation
for their time. This study had received ethical approval by the university research ethics
board.
Data Analysis
A thematic analysis was carried out in which the data were analyzed deductively,
using a constant comparison approach (Braun & Clarke, 2006). Audio-recordings were
first transcribed verbatim, where pseudonyms were assigned to each participant to ensure
confidentiality. Following transcription, the focus group data was read and re-read by
myself to become familiar with the data. Codes were then developed in order to denote
important units of meaning. These “meaning units” consisted of words and phrases that
reflected and were indicative of student’s interests in physical activity and perceived
barriers to participation. For example, as participants repeated them throughout the
study, words that reflected barriers such as “not enough time” “other interests” and
“feeling intimidated”, were coded throughout the transcript. After each individual
transcript had been repeatedly read and coded, in the second level of analysis, all of the
participants transcripts were read and coded again; common meaning units were grouped
together in order to form provisional themes. For example, words such as “time,” “work,”
“academics,” were all coded into a broader theme which encapsulated the essence of
94 Ph.D. Dissertation – M. Kwan
these meaning units: shifting priorities.
Emergent categories and themes were
continually being challenged, by asking whether the data was central to one of the
research questions. As recommended by Braun and Clarke (2006), the process remained
flexible, meaning that themes could be modified and refined until the most reasonable
reconstruction of the data was completed. This meant that over the course of this
process, transcripts were re-read to ensure that the final thematic structure was applicable
across all the transcripts.
Issues of Trustworthiness
When conducting research, it is imperative that researchers be mindful of issues
that make their findings legitimate, and replicable – and in qualitative work, produces
research that is ‘trustworthy’. In quantitative research, validity of research is often
related to accuracy, relevance, and reliability in the various measures being used – using
tests that can be easily computed (e.g., psychometric tests) within a statistical software
package (Pyett, 2003). Criterions surrounding legitimacy and accuracy in qualitative
research, however, are not only less established but often not agreed upon (Biddle et al.,
2001; Morse, 1999; Morse et al., 2002; Sparks, 2001). Trustworthiness and rigor are two
commonly used terms within qualitative research, concepts used to capture accuracy,
credibility, transferability, dependability and confirmability (Bloomberg & Volpe, 2008;
Chiovitti & Piran, 2003; Kreuger & Casey, 2000; Morse et al., 2002; Sparks, 2001). In
other words, the research process must be verifiable; and without trustworthiness or rigor,
the research becomes worthless and something fictional (Morse et al., 2002).
The
purpose of the current investigation was to obtain data reflective of the natural
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occurrences of a first-year university student.
Therefore, several methodological
strategies for demonstrating the study’s trustworthiness were used to ensure that the
findings of this research were reflective of the actual experiences that these first-year
students encountered. One strategy was the use of a personal journal. Transparency has
been an issue plaguing qualitative research (Biddle et al., 2001); and in an effort to
provide transparency, the journal acted as an audit trail documenting the research process.
The journal began at the planning stages and continued until the completion of the data
analysis. This personal journal included reflections made throughout the research process,
as well as a reflection made following each of the focus groups. This provided an
additional reference during the data analysis process.
Another strategy used to increase trustworthiness was member checking.
Member checking has been another popular method researchers use to obtain further
verification around interpretations of the study (Morse, 2002).
Typically, member
checking often includes the researchers providing a summary of the results to the original
focus group participants for verification; however, several authors have cautioned against
this strategy (Hammersley, 1992; Morse, 2002). The argument is that focus group data
becomes synthesized, abstracted and decontextualized; therefore, little of the content
would be easily recognizable and perhaps applicable.
In fact, Morse suggests that
member checking may actually be more of a threat to validity rather than a method used
to enhance validity. Consequently, member checking was conducted within each focus
group. When key ideas were identified, the moderator would summarize the idea and
96 Ph.D. Dissertation – M. Kwan
reframed it as a question. The purpose was to have participants either confirm or clarify
that interpretation.
In the final attempt to further obtain trustworthiness of the research findings, the
lead author (MK) sought the consultation of a physical activity expert (GF). An initial
meeting prior to the start of the focus group was conducted to discuss the scope of the
study and review the interview guide. Following the completion of the focus group
interviews, half of the focus group transcripts were given to GF to review. Another
meeting was conducted after GF had the opportunity to review the transcripts, to discuss
issues around the coherence of data collected, and themes and patterns that subsequently
emerged (i.e., how it all fits together). While there was general agreement in the themes
relating to physical activity barriers and for students’ preferences for an intervention,
there were disagreements in the themes related to students’ perceptions of physical
activity. As suggested by Kreuger and Casey (2000), these discrepancies were discussed,
until consensus was reached. The results presented below represents the themes agreed
upon by both MK and GF.
Results
The current study had three overarching focuses. In an attempt to understand how
physical activity is regarded during students’ transition into university, the first purpose
of the study was to examine first-year students’ perceptions of physical activity. The
second purpose of the study was to determine the salient barriers that first-year students
encounter during their transition into university, specifically obtaining an in-depth
understanding behind the factors that contributes to the declines in their physical activity
97 Ph.D. Dissertation – M. Kwan
behaviours. Finally, in an effort to inform future intervention development, the third
purpose of this study was to establish some of the preferences that students have towards
a prospective physical activity intervention. Each of the study focuses will be addressed
in sequence, with quotations inserted to emphasize and illustrate ideas and relationships.
Comparisons were made between first-year students living on-campus and off-campus,
and any differences between these groups are also highlighted.
Perceptions of physical activity during the transition to university
To gain a better understanding around the perceptions of physical activity during
students’ transition into university, participants were asked general questions pertaining
to their experiences during their transition into university, and the declines in their
physical activity participation. Overall, students acknowledged that there were many
changes associated with the transition into university, including a noticeable shift in
priority towards academics. Despite being less active at university, however, physical
activity was still regarded as an important behaviour – retrospectively wishing they had
incorporated more activity during their first year at university. The problem was that
academics became increasingly the focus during this transitional period; and as a result,
students appeared ambivalent in terms of how physical activity participation fit into their
first-year university life.
Generally speaking, students recognized the importance of being physically
active, including some students expressing concerns for not being more active.
A
number of students made similar remarks to Karen when she said: “It makes you feel bad
[being less active] because you know it’s good for you. It keeps you healthy and
98 Ph.D. Dissertation – M. Kwan
everything, so you know you should be doing it (Karen).” Other students provided further
anecdotal accounts on the perceived benefits of physical activity:
I know that when I am really stressed and everything, I would go down to the gym
at like 2 in the morning, just to get some frustration out. I feel better after that, and
I know it’s good for you, but I just don’t get doing it enough (Josh).
My sister came and went to university and she was telling me, like start going to the
gym as soon as possible because it can relieve your stress, especially during
exams… run or workout or play basketball or something… because it just relaxes
your body. So it’s a good thing to do not just in terms of health, but also for focus
(Ben).
Considering that many of these students associated physical activity with positive
benefits, perhaps not particularly surprisingly, most students entered university with the
intention of being highly active. Many recalled their early desires of participating in a
variety of activities as they entered into university.
Well, I came in here thinking I would swim everyday or something, cause they have
a number of swimming pools you know. But that just didn’t happen (Hope).
I [got to university] and like Yes! This is going to be my best 4 years of my life.
I’m going to work out everyday and like get smart and go to school, it’s going to be
great (Joe).
Students’ positive intentions became mitigated, however, when the realities of
academia became apparent. Given the greater demand and the increased workload at
university, it became increasingly clear that academic-related activities became the top
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priority. There was a definitive shift in tone of the focus group discussions, which began
with students recalling their excitement about entering university, and how this greater
independence and newly acquired autonomy meant that there were opportunities to try
out new sports or activities, to the impetus being around studying. As a result, students
became increasingly ambivalent towards physical activity. Julia, who was among the
many participants who had entered university with strong intentions to be active, summed
it up accurately when she stated: “as the semester went on, physical activity just gets
neglected (Julia).”
Despite identifying some of the short and long term benefits
associated with physical activity, when it came down to a decision to engage in physical
activity, students gave it lower priority:
It’s like I realized I’m in university now, it’s even more like I have to try harder in
school, so when you start to bring up exercising in the equation, it’s like shouldn’t
you be devoting this time to your studies instead? (Joanne).
I guess for academics in university… being athletic weighs against how you are
doing in school, so it’s like a trade off. So if you do more sports and exercise, and
then that time can be used towards studying, so which one do I care about more?
Like I want my diploma, but where is my exercise going to get me? I’m not going
to be an athlete… so I’ll be like I should focus and spend more time investing more
time to studying. (Diana).
Given that there were both positive and negative feelings towards time being spent
on physical activity, a key question became whether or not students had any interest in a
physical activity program [intervention] aimed at helping first-year students be more
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active during their transition into university. The ambivalence that students exhibited
may have broader implications for future intervention efforts.
If students are not
accepting of the physical activity intervention concept, then the chance of its success
would be minimal.
However, the results were positive, and students were
overwhelmingly in favour of the idea. In general, students thought that a potential
program would be beneficial, helpful, and was something they wished they had. For
example, Deb stated: “I think a lot of 1st year students would be open to that, open to a lot
of new things. Like giving the information about the hours and place… that just helps…
(Deb).” The caveat, however, was while students were in favour of the intervention
concept, there was also a varying degree of skepticism towards its potential effectiveness,
including many students making similar remarks to Jake when he stated: “[the
intervention] probably won’t have super huge effects on the numbers, but will it help?
Definitely! (Jake)”
Collectively, the results indicate that physical activity has positive meaning among
the first-year university student population, and that most students enter university with
the desire to be physically active. However, among the many changes occurring during
the transition into university, students found themselves shifting their priorities towards
academics, de-emphasizing the saliency of physical activity. While students recognized
the importance of physical activity, it appeared just not as important, and subsequently
neglected. Despite this ambivalence, students did indicate that there would be interest in
an intervention aimed at helping first-year students’ physical activity, and that a program
for this would be beneficial and something worth exploring.
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Physical activity barriers during first-year university
The exploration of physical activity barriers students faced during their transition
from high school to university was guided by Sallis and colleagues (1999) social
ecological model. Emergent barriers were categorized as intrapersonal, interpersonal,
environmental/community, or societal type barriers. Salient barriers that emerged during
the focus groups interviews are highlighted within each of their respective categories.
Intrapersonal Barriers
Intrapersonal barriers reflect the factors internal to the individual that prevents or
hinders their ability to participate in physical activity. As previously mentioned, it was
clear that students were eagerly anticipating greater independence, freedom, and
autonomy associated with being at university. However, the transition into university and
this newfound independence left many students feeling lost, especially in regards to the
concept of time. This perhaps relates to the notion of the shifts in priority – with the
greater impetus around academics – and the perceived lack of time was continually cited
to be an important intrapersonal barrier:
I feel like I’m on a tight time budget. I’d come home from class and like I’ll have
time to do homework and I’ll sleep for a bit and like have time for dinner… Then
it’s like 8:00pm, [you drag your feet], and then it’s like 10:00pm and you’re like I
can’t go to the gym now (Ken).
Thinking that you had control of everything that you eat and [physical activity],
but then it’s like when you get here [at university], you’re even worried about
grabbing something fast to eat and stuff, you just don’t have much time (Frank).
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Issues around scheduled time were clearly evident, but the results also showed
that many students lacked the confidence in their ability to manage their time. Many felt
that it was too easy to procrastinate, while others just felt that they lacked control of their
time:
I find myself with a lot less time than I did before, and I’m not completely sure
why… I actually thought about this lately because high school takes like a chunk of
time, like 7 hours out of your day, and like university classes, in a day like I would
have 4 hours of classes or something on average… yeah, I can’t figure it out, it
really kills me that I think I have less time (Joanne).
Well, I tend to leave things till the night before, and I get so angry with myself, like
why do I do that to myself? Like I mean my life would be so much easier if I was
able to manage my time, my whole life (Alicia).
In high school, they manage your time for you pretty much… and now in university
it’s like here’s what you need to do, go do it…
it’s a learning experience
(Harrison).
Harrison’s point was consistent with others who felt that learning to deal with the
rigors at university was a constant learning experience. Prioritizing academics meant that
much of students’ time and energy had to be dedicated to school leaving them with less
motivation for physical activity. Students often talked about laziness as another issue that
contributed to their declines in physical activity. As Joe explains, “yeah… the problem is
that you have a class, then another class, and some time in between you may be able to do
something, but you get lazy… then you finish sometime in the afternoon, go for dinner,
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then got to get some work done, but the time you’re ready to do something, it’s like 9 or
10, and again, you’re feeling lazy to do anything but to [vegetate] in front of the TV or
something (Joe).”
The second intrapersonal barrier that emerged was students’ intimidation in
engaging in physical activity on campus. Across the focus groups, there was a lot of
discussion around how many of the students lacked the inclination to participate in the
physical activities being offered by the institution.
Specifically, participants felt
intimidated with the programs that were being offered – perceiving that the activities
available were being targeted to physically fit and highly knowledgeable students (e.g.,
competitive sports, advanced exercise classes). As a result, students like Mike had an
inherent fear to participate because of perceived pressures to perform, “I’ve seen like the
posters up, like with saying join intramurals or whatever, but to me, it’s kind of
intimidating. Because thinking, I’d just show up, I’m not very good, and I don’t know
them (Mike).” Similarly, many of the others indicated that they felt disheartened as they
felt competition drastically increased.
Given the dramatic increase to the student
population at university, students felt that there was a larger pool of athletic talent.
Therefore, they perceived that their own athletic abilities were inferior to other students,
making it difficult to participate:
Like you said about sports not being as much fun anymore, I mean like I was never
really competitive at sports, and now [at university] you have all these elite people
involved. It’s like another world, so if you want to be involved, I don’t want to have
to be like go try out [for intramural sports] or anything like that (Sophie).
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Not only that but you are going to find a lot of people definitely better than you,
like in everything. I mean in high school, let’s say you are the best at one sport and
everybody would think you are the best athlete.
But here you come, you’re
nowhere near any of these people, and other students are much better than you, so
you think there’s just no point… (Jay).
The idea around intimidation extended beyond the context of competitive sport.
Many others within the focus groups were like Julia; intimidated because they felt selfconscious about themselves doing physical activity: “Maybe it’s like a confidence factor
or something… when you exercise, generally, people tend to look at you and you look at
other people right? Sometimes you won’t judge others, of course, there are not a lot
people who would do that right? But there are some who do… There are other people
who perceive that and it put other people in a situation where they kind of don’t want to
[go] because it seems kind of embarrassing… (Julia).” Ultimately, students’ trepidation
around the institutional programming and facilities appeared to have hindered their
physical activity participation during first-year university.
Interpersonal barriers
Interpersonal barriers are external factors that emphasize both formal and
informal social networks and social supports systems. The results of this study indicate
that the changes in social groups during the transition into university were an important
physical activity barrier, and regardless of whether they lived on campus or off, changes
in social groups were inevitable. Many students encountered a similar experience to Rob,
who stated: “All my friends went separate ways after high school… some went off to
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other universities, so it was [kind of] like starting over again (Rob).” Due to the vast
changes in social groups, it appears that many found it difficult to form social
relationships for purposes of physical activity. As Katherine states, “Back in high school,
I would enjoy [physical activities] more with my friends and stuff, but now it’s different,
you know, sometimes we would go as a group of friends to drop in, and that would be
fun, but going on your own, or trying to get on a team, it’s not as fun… It’s too hard
(Katherine).” Instead, what used to be social engagements in the form of physical
activity became displaced by other sedentary behaviours:
You know, we used to go out after school to do stuff [sport activities]…It’s just
easier to go out to eat now. After classes and all that, you just want go chill and
eat, there are so many good places close by (Tom).
It’s different… You meet people in your class and they have [similar academic]
interests… it’s more like making new friends, people you can study with (Sarah).
This idea is again related to the notion of students’ shift in priority. It appears that
students are forming relationships based on scholarly commonalities, and socialize
around class. In addition to peer influences, the results also found parents being a
potential physical activity barrier to some students. As much independence as some
students feel they had entering university, a lot of students shared similar sentiments to
Sophie who felt external pressure from her parents to solely focus on academic-related
activities – particularly if the parents perceived little value in physical activity: “I think
that parents have strong influences… and they really only see you need money for a
calculator or a pen, not so much for physical activity… They tell me to do homework,
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they don’t tell me to go out and play sports… they only see the negative impacts of the
activity [risk of injury] and never really see the wholesome or health that comes from
[activity] (Sophie).”
Conversely, a number of participants indicated that their parents were supporters
and advocates of a physically active lifestyle. Ashley describes: “Well, my dad is pretty
pro-working out and staying fit. I think he started a few years ago, and noticed the
benefits. So he wants me to do some bodybuilding and stuff… he is like anything you
want to take, just take it and I’ll go pay for it (Ashley).”
Given the conflicting accounts,
the findings suggest that parental influence is still salient as students enter their first year
at university, and can be both a barrier and facilitator to their physical activity.
Environmental/Community barriers
Environmental and community barriers are relationships among organizations,
institutions, and informal networks which hinder an individuals’ ability participate in
physical activity. Two of these overarching barriers were identified, specifically around
the institutional environment and distance for students living off campus. Interestingly,
the majority of students perceived that the university was not a place that was conducive
for being active. It was not an issue geographically, but students recalled the difficulties
adjusting to the mentality of a new and much larger educational institution, and how
different it was compared to high school. One of those themes consistently emerging
related to academic programs and requirements, and how institutional expectations
negatively affected their physical activity behaviours:
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It’s so hard to stay on top of things. Even if you finish all your mid-terms, there are
the papers and assignment, and before you know it, it’s already finals…
[university] was definitely more [difficult] than I was expecting (Bree).
I think it’s [physical activity decline] a huge accumulation of the workload.
Because the atmosphere is like you got to get this done by this day, so everybody is
trying to get it all done, I think people just don’t worry about what’s going on on
the outside… we’re all just like zombies (Brad).
While it was agreed that workload was much heavier at university, the interesting
finding was that students perceived receiving little support from the university in
facilitating physical activity participation. This was in stark difference to high school
where students recalled receiving constant information about activities being offered oncampus. While the university where the focus groups were held offered students with
three large public-use facilities, the consistent theme was that participants received little
information about these, and did not know what activities or opportunities were available
on campus:
I probably would have gone to [do more activities] had I gotten more information
about it… I mean I signed up at the beginning of the year to an e-mail list but I
didn’t get any of the information (Kit).
It really made me mad one time I saw a bunch of people playing in this soccer
league. I had signed up this one society soccer thing at frosh, and they told me that
I would get an e-mail. I only found out about it when I saw them (Ben).
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I hate the fact that you have all these intramural things that are the only things that
get a lot of attention… There is just not a lot of information. They don’t tell you
much other than those try-outs. Even frosh week, the tour is like…’the gym is
there, and you can do that there’, but you don’t even to actually see it. (Joe).
It’s not like we get a lot of information about sports teams and stuff… the [athletic
centre] website is so stupid! Even when you try and find out the information, you
get sent to this link and that, you get a schedule… it’s like why am I wasting my
time? Had I had more info, I would have been more motivated (Josh).
Overall, students perceived that the university did a poor job of marketing oncampus activities, and that the information that the institution provided was neither easy
to obtain nor convenient to access.
The results suggest that the perceived lack of
awareness and the absence of information appeared to be a salient barrier for many
entering this new environment.
The second environmental/community barrier that emerged from the focus group
related to those students living off-campus. While few differences emerged between
students living on and off campus, the distance in which commuting students was an
additional barrier that only students living off-campus had to contend with. The distance
itself had a negative impact on students’ physical activity behaviours in several ways,
including feeling fatigued following their daily commute to school and back:
Commuting tires you out a lot. Even sitting on the train and the bus, I find it
really draining, and it takes away from a lot of my energy... I mean when you are
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crushed like sardine during rush hour and stuff, and having to hurry to catch the
next train or bus, it just all adds up (Ed).
I just want to go home. Like it takes an hour and a half to go home anyway, so I
don’t want to have to go work-out (Sarah).
In addition to time and energy associated with the commute, another interesting
finding was that off-campus students felt detached from student life and perceived having
fewer opportunities to be active around campus. As Richard explains, “I would say I feel
being a commuter, I feel a little more detached… I mean, I have to go all the way from
home, taking like at least a half-hour to hour to get to places and stuff. I mean it’s not
that much, but like you [kind of] want to get home after classes, and you don’t want to
have to look for a place to chill or whatever, just so I can play a game of basketball. So
there’s less of a motivation to get yourself involved (Richard).”
Off-campus students also found it less convenient to engage in physical activity
on campus because the difficulties associated with bringing the necessary clothing and
equipment to the university campus: “For a lot of the sports you actually have to carry
around the racquets, the gym clothes, the gym bag… you already have textbooks,
notebooks, pencil case, laptops in your bags, on top of that you have carry all of these?
No… (Ashley).”
Overall, it appears that the physical distance was a significant
difference between students living on and off campus, and is an additional issue that
commuting students are forced to deal with.
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Societal barriers
Societal barriers represent public policy and laws, governed at the local,
provincial, or national levels. Overall, there were very few societal barriers that students
felt hindered their physical activity participation.
While a few of the participants
indicated that it was somewhat daunting for them to be moving into a large metropolitan
centre, it was not a salient theme among the focus groups.
Opportunities for intervention
The final focus of the current study pertains to preferences around the prospect of
an intervention aimed at attenuating the declines in physical activity behaviours during
first-year university. More specifically, given the positive response towards the prospect
of a physical activity intervention, the purpose was to solicit students’ preferences for the
delivery of a physical activity intervention. Throughout the discussions, participants
identified convenience and accessibility as the two critical aspects of a successful,
prospective physical activity intervention.
Many of the focus group discussions started around the idea of physical
education/activity classes, or special residence floor meetings. Interestingly, however,
each of the discussions concluded that classes or meetings would be either too time
demanding – particularly when time was already a perceived barrier. Many students
echoed Joe when he stated: “I think meetings would be pretty pointless here now. I
would suggest meetings, because it seems like the most accurate things to do, but I can’t
see it working. Nobody really goes to things like floor meetings [events not mandatory]
(Joe).” As the discussions further developed, it did not take long for students to suggest
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the Internet as a convenient and accessible way for a physical activity intervention to be
delivered. As Bree and Rob discuss, the Internet is a critical tool that students use:
I think that something on the Internet would be a good idea, because personally,
I’m online all the time and I think it’ll be more effective than other forms of media
like handling out flyers and stuff (Bree).
I think that would definitely have a lot more, like it would be spread to a lot of
people, cause the Internet is, you know… indispensible nowadays, and you almost
can’t live without the Internet (Rob).
While it became evident that a clear consensus around using the Internet was
reached, there was less agreement around what the intervention should look like. For
example, some of the participants liked the idea of creating a new domain for a new
website that students could access to obtain physical activity-related information; while
others suggested using e-mail to deliver tidbits of physical activity-related information.
However, one idea that did resonate among students was to use an institutional portal
called Blackboard:
I can even think of one for you right now, portal/blackboard. You put it on there,
cause people have to check it, they get their lecture notes, and they get their
homework there, it’s like you have to go (Ashley).
I think Blackboard is good because you are already on there checking on your
school stuff, so why not try and check out something that is fun, and like escape
from the school stuff (Brian).
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Similarly, some of the students suggested the use of social media sites, such as Facebook.
The reasoning for this was because many of their friends and peers were users of these
sites; so they felt that an intervention delivered through social networking sites could
attract the most attention:
I like Facebook because it can contact or activate you [in a] social group and with
biome [another institutional portal] and like portal, I don’t’ think that’s possible,
because they don’t sense who you are (Sophie).
So I’m like thinking that if it was a more of a social network, it would feel more
fun… (Julie).
Overall, students perceived that the transition into university was a good
opportunity to intervene, and that the Internet would be an ideal vehicle to deliver any
intervention.
Both easily accessible and convenient, they agreed that delivering
important information to students via the Internet would be something that is feasible and
potentially helpful. It was interesting that there was a dichotomy of responses, including
some students feeling that an intervention would be best delivered through social media
sites, while the other students felt that an intervention would be better delivered through
an institutional portal. Both options have similar attributes, and it is clear that students
would prefer to have an intervention delivered through something that they already use,
or are at least familiar with.
Discussion
The results of the current study provide a population-specific account of the
perceived interest in physical activity, physical activity interventions, and identifies the
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salient barriers to physical activity participation. Overall, the specific accounts provided
by the first-year students provides a more comprehensive picture of the transition into
university, and the impact that it has on students’ perceptions of physical activity and the
factors related to their declines in physical activity participation. Additionally, students
provided specific feedback on intervention preferences which will be informative towards
the development of an intervention aimed attenuating declines in physical activity.
Perceptions of Physical Activity
The transition into university was an obvious life-changing experience.
In
contrast to high school, the sudden increase in autonomy and independence was clearly
associated with declines in physical activity. Lacking the support and structures in place
at high school, these students did not seek out information or opportunities to be
physically active on a regular basis despite being broadly appreciative of the benefits of
physical activity. Students also reported devoting more of their time, focus and energies
towards academic-related activities.
Whether the impetus to focus their efforts on
academics were internal (from themselves) or external (parental influence), it was clear
that students wanted an education – or at the very least, the grades to obtain their degree.
As a result, academics became students’ primary focus and alternative activities
(including physical activity) became secondary. Despite the positive attitudes and fruitful
intentions to be active as they entered university, it became evident that students became
ambivalent towards physical activity as they began to embark on their university careers.
The ambivalence students exhibited reflects negative changes to physical activity
motivation, which can be attributed to their shifts in priorities. This is consistent with
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previous research demonstrating instability in physical activity motivation as individual’s
transition out of high school. A number of studies have identified a shift in physical
activity motivations from high school to a year following their graduation (e.g., Martin,
2008, Martin, 2010). The results of these studies found decreases in adaptive physical
activity cognitions (reflected by individuals’ positive attitudes and orientations
addressing confidence and valuing of physical activity), adaptive physical activity
behaviours (positive behaviours associated with physical activity such as planning,
management, and persistence) and increases in maladaptive physical activity behaviours
(reflected by reduced physical activity motivation and comprising of concepts such as
avoidance and disengagement) (Martin, 2008; Martin, Tipler, Marsh, Richards, &
Williams, 2006). Physical activity motivation is an important factor in physical activity
maintenance, and ones ability to convert positive intentions into actual behaviours
(Martin, 2010; Martin, et al., 2006; Smith & Biddle, 2008); therefore, physical activity
motivation appears to be an important target for interventions. In an effort to lesson the
ambivalence students have towards physical activity, interventions need to address the
declining adaptive cognitions, facilitating greater self-efficacy, mastery, and valuing of
physical activity behaviours.
Interestingly, despite students being ambivalent towards physical activity,
physical activity was still perceived to be important. Similar to the findings of Kwan and
colleagues (2009), the results of this study found students’ having positive attitudes
towards physical activity. This finding has important implications, given the strong
relationships found between first-year students’ attitudes and their physical activity
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intentions and physical activity behaviour (Kwan & Bray, 2009; Kwan et al., 2009).
Students’ positive evaluations may in part be due to their knowledge and broad
understanding of some of the benefits associated with physical activity. However, it was
interesting that many of the benefits students identified with were largely futuristic health
outcomes (i.e., helps you live longer). The problem is that most first-year students do not
have strong consideration of future consequences (Kwan, Bray, Woodgate, & Gyurcsik,
2007). Consideration of future consequences (CFC) is the degree to which one would
consider distant versus immediate consequences of a potential behaviour (Strathman,
Gleicher, Boninger, & Edwards, 1994); and because students’ perceptions of physical
activity benefits are largely distal rather than acute, they are more likely to engage in
activities with immediate gratification or short term consequences (i.e., studying).
Although CFC is a trait considered to be amenable to change (Strathman et al., 1994),
implications of these findings suggest that intervention efforts may need to focus on
educating students on the short-term benefits of physical activity; specifically
highlighting some of the acute benefits of physical activity as it relates to academic
achievements (e.g., having more energy; better ability to concentrate).
Salient Barriers to Physical Activity
Given the positive response towards a prospective physical activity intervention, a
greater understanding around the salient barriers will help towards developing strategies
to accompany theory-based research. The focus group participants identified several key
barriers that had prevented them from being more active.
While the results found
students encountering few societal barriers, a number of intrapersonal, interpersonal, and
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institutional barriers were identified. These barriers represent the specific experiences
that the first-year student population encountered, offering relevant insight towards
potential targets in the development of an intervention.
As mentioned earlier, a large proportion of the focus group discussions revolved
around students’ academic commitments. Related to this point, the most common barrier
identified were issues associated with time.
While students often reflected on the
academics-related stresses (heavy workload, increased expectations), students would
often point out issues of time constraints and time management. Interestingly, while the
lack of time was often a focus, students conceded that they probably had more time than
they initially thought. Time was identified as something that was just easily displaced
(e.g., wasting time on the internet while researching for a term paper). Even if students
found themselves with some spare time at days end, laziness emerged as another factor
that negatively impacted students’ physical activity behaviours. Whether this is related to
students’ ambivalence or not, recent evidence suggests that the lack of time management
and laziness may be related to self-regulation. Self-regulation is the ability for a person
to control ones own behaviour without external control or monitoring (Baumeister,
Heatherton, & Tice, 1994), and that self-regulatory strength is considered to be a finite
resource that can become depleted when people use it to control thoughts, emotions, and
behaviours (Muraven & Baumeister, 2000; Rovniak, Anderson, Winett, & Stephens,
2002). Within the context of a university student, academic demand continues to draw
self-regulatory resources. Speculatively, students will draw on emotional, cognitive, and
behavioural demands during an average day at university. Given this depletion in self-
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regulatory strength, it may be understandable at the end of the day, students are left
feeling lazy and lacking the motivation to exert further energy. This is consistent with
recent research showing self-regulatory depletion being associated with increases in
fatigue, decreased physical activity planning, and decreases in the frequency and exertion
of aerobic exercises (Bray, Martin Ginis, Hicks, & Woodgate, 2008; Martin Ginis &
Bray, 2010). However, learning self-regulatory strategies to cope with the demands of
school may help in the reduction of stress and the onset of fatigue, and greater selfregulatory strength to participate in more physical activity (Ax, Gregg, & Jones, 2001;
Degotardi et al., 2006). Strategies such as implementation intentions and goal setting are
two specific examples that can help students regulate themselves better, and are strategies
that have been shown to be effective mediators between intentions and behaviours
(Ajzen, 2006; Gollwitzer, 1999; Smith, Hauenstein & Buchanan, 1996).
Another salient barrier that emerged related to issues of intimidation.
For
example, students expressed concerns with their self-presentation, or the competitive
nature of the activities offered. These concerns have important implications, given a
recent study showing barriers relating to self-presentation and affect being the most
robust predictors of students’ self-efficacy to cope with barriers (Kwan & Bray, 2009).
Given that students’ coping self-efficacy is largely dependent on barriers such as
intimidation, and that coping self-efficacy is a predictor of physical activity (e.g., Bray,
2007; Gyurscik et al., 2004), issues around intimidation need to be explicitly addressed.
The problem is that many of these concerns stem from institutional programming (e.g.,
not provided with information; activity being catered to the advanced); therefore, the
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findings suggest that institutions, at the policy-level, must do a better job marketing
physical activity opportunities to their students, and providing them with a range of
options that reduces fears or concerns.
It should be noted that when students talked
about ‘being physically active’ they commonly used examples related to structured
and/or supervised activities such as team sports or exercise classes. This reinforces the
need to provide students with exposure to a broader range of habitual and lifestyle
physical activities both before and during university.
Another adjustment required during the transition into university related to
changes in social groups and social network. Although these social barriers were not as
well discussed as some of the issues earlier, it is worthwhile to highlight that changes in
students’ social networks had a profound impact on their physical activity behaviours.
The transition into university often meant that students entered university with less
familiarity with others. As a result, many students no longer had the friends who shared
common interests in the sports/activities, and were less motivated to join new teams or
activities.
Instead, student found themselves meeting people with academic
commonality, and social activities shifted from physical activity to more sedentary
activities such as going out for dinner or studying. Research has shown group norms and
peer influence to be an influential factor in physical activity (Rivis & Sheeran, 2003), and
future intervention work should create and facilitate opportunities for new students to
meet and find others with similar physical activity interests. However, it should also be
noted that socially-based interventions are more likely to be effective if developed in
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concert with strategies that enhance individual’s motivation and skills for being active
(Heaney, & Israel, 2002).
Comparison of Residence and Commuting Students
Focus groups were stratified to reflect first-year students living on campus in
residence, or living off campus. The results of the current study suggest that the first year
student population is a fairly homogenous group with respects to their perceptions of
physical activity, suggestions for physical activity interventions, and for many of the
physical activity barriers. However, commuting emerged as an important barrier evident
for students living off-campus. The current study found students living away from
campus having less discretionary time and less motivation to participate in physical
activity. While some research has found little differences between physical activity
behaviours between university students living on-campus and off-campus (Brevard &
Ricketts, 1996), there has been other research that has found advantages for off-campus
students living at home in terms of physical activity maintenance (Bray et al., 2004). The
caveat, however, is that Bray and colleagues’ study was conducted at a small university
institution – located in a smaller urban centre. The institution of the current study is
located in a larger urban centre, where commuting times for most students were quite
substantial. Setting aside an extra 30 to 90 minutes each day for physical activity may be
even more difficult for students having to travel an additional 1 to 3 hours every day. In
general, students living away from campus were forced to deal with another level of
complexity in addition to the other salient physical activity barriers that students living
on-campus face. Implications of this finding suggest that intervention efforts may need
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to be tailored differently to students who live on-campus and students living off-campus.
For example, interventions aimed at commuting students may want to incorporate greater
emphasis on community-based facilities, or with non-leisure time physical activities such
as active transportation.
Delivery of a Physical Activity Intervention
Given the positive response towards a physical activity intervention, it was
important to acquire feedback in terms of students’ preferences. There has been previous
research suggesting that the Internet could be an important tool in the delivery of healthrelated information (Kwan et at., 2010; Vandelanotte, Spathonis, Eakin, & Owen, 2008),
and current findings confirmed those findings in that students wanted a prospective
intervention to be Internet-based.
Convenience and accessibility were the primary
reasons for why students preferred an Internet-based intervention. Although many of the
focus group discussions explored the possibility of a class-based physical activity
intervention, the inevitable conclusions drawn suggests time commitment and
institutional bureaucracy would make a class-based intervention difficult to successfully
implement. Instead, an Internet-based intervention was perceived to be more feasible –
and also more convenient and accessible to the student population.
Facebook (i.e., social media outlets) and Blackboard (an institutional web-portal)
were the two most common platforms suggested by the students. Students explained that
an intervention delivered through these channels would be beneficial because it was
something they would normally use, and were familiar with. Social media sites such as
Facebook are popular with this student population and these could be utilized to address
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some of the social barriers raised by this population. However, an advantage of using an
institutional portal would be its potential reach (i.e., every student having access).
Additionally, because there has been research to suggest that institutionally-based sources
are perceived to be more believable and credible sources of health-related information
(Kwan, et al., 2010), an intervention delivered through a university affiliated site may be
advantageous. In summary, it was agreed that the Internet was the ideal channel for
which a physical activity intervention should be delivered. Despite popularity with social
media sites, research should explore the feasibility of delivering a physical activity
intervention through an institutional portal such as Blackboard.
In considering the
eventual goal of developing a population-level intervention that can be easily applied to
other universities, portal Blackboard has many attractive features.
Most notably,
Blackboard has tremendous reach across Canadian post-secondary campuses, as well as
with the students, who are often required to access Blackboard for the purposes of school.
Strengths and Limitations
Despite the important contributions of this study, there are several limitations
worth mentioning. First, there may have been issues of social desirability. Recruitment
of participants was made primarily via posters and advertisements; therefore, the study
may have captured students who may have been more interested in issues of physical
activity to begin with. Second, sampling selection was primarily based on the self-report
in a decline in physical activity during the transition as this is the target audience of a
future intervention. However, it may have been informative to interview students who
had maintained or increased their physical activity participation during this transition.
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Exploring similarities and differences in experiences might shed light on how best to
intervene and this could be the focus of future research.
Although there were several limitations to this study, there are several strengths of
the study that should be highlighted. First, to my knowledge, there has been no published
research that has used qualitative methodologies in an attempt to better understand the
declines of physical activity participation among students transitioning from high school
to university. In particular, the use of focus groups was advantageous. Participants
interacted well together, and emergent themes were a product of these discussions, which
may not have been fully captured if individual interviews were conducted. Secondly, the
study design provided the flexibility to make comparisons between students living on
campus to students who were living off-campus. While the findings did indicate that
students shared many similar concerns in terms of their physical activity participation,
there were several additional barriers that off-campus students identified, which suggest
that intervention efforts may need to target these cohorts differently.
Summary
Given the complexities associated with physical activity behaviour during the best
(i.e., the most stable) of times, an in depth examination of a first-year student during their
transitional period was necessary.
Overall, the results of the current study further
reinforced some of the findings of previous research, while providing a richer breadth of
understanding around first-year students’ physical activity cognitions and physical
activity behaviours. Implications from these findings suggest that future interventions
need to target students’ adaptive behaviours and self-regulatory skills, in an effort to help
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facilitate greater physical activity motivation and physical activity behaviour. While
students should not be discouraged to prioritize academics, the dissemination of
information regarding the benefits of physical activity should be tailored to emphasize the
short-term, academic-related benefits of physical activity. This may help reduce the
ambivalence seen regarding physical activity. Providing students with the self-regulatory
tools to adapt behaviours among competing time demands will also be necessary. There
was interest in receiving support to be more physically active. Students identified the
Internet as the most convenient, accessible, and preferred method of intervention
delivery. Collectively, this understanding will help inform the development of future
physical activity interventions aimed at attenuating the declines in physical activity for
students transitioning into university. Once developed, future research will need to
examine the acceptability and feasibility of such intervention programs, working towards
the implementation of large-scale institutional initiatives.
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Table 1
Overall demographic characteristics of focus group participants (N = 45).
Sample Total
(N=45)
Characteristics
Residence
Off-Campus
(n=24)
(n=21)
n
n
18.64 (+ .98)
18.73 (.89)
Males
8
11
Females
15
9
High School
6.42 (+ 4.61)
5.64 (+ 4.01)
First-year University
3.11 (+ 2.50)
2.97 (+ 2.64)
Mean Age
Gender
Moderate-Vigorous Physical Activity
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CHAPTER 5
Active Transition: A pilot study of a website-delivered
physical activity intervention for university students
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Active Transition: A pilot study of a website-delivered physical activity
intervention for university students
A lack of sufficient physical activity is a critical public health issue. Despite the
well known health benefits of physical activity (Dishman, Washburn & Heath, 2004;
Haskell et al., 2008; Janssen, 2007), the majority of the Western world does not accrue
recommended amounts of activity (Dishman et al., 2004; Kimm et al., 2005).
Interestingly, while many adults are now considered to be physically inactive, data
suggests that many were significantly more active as children and adolescents (Andersen
& Haraldsdottir, 1993; Gordon-Larsen, Nelson, & Popkin, 2004). This is consistent with
trends across the lifespan that show children and youth being the most active segment in
the population; and as this youth population moves toward young adulthood, accelerated
erosions in physical activity behaviour become evident (Caspersen et al., 2000; GordonLarsen, et al., 2004). While it is often assumed that the age-related decline in physical
activity is linear, there are several points in time where disproportionate declines in
physical activity occur (Curtis, White & McPherson, 2000).
One period at which dramatic declines in physical activity occur is during young
adults’ transition out of high school. There have been numerous studies, irrespective of
the different physical activity measures used, which have consistently found young adults
being far less active during their first-year at college/university compared to the months
leading up to their transition. More specifically, the data shows significant declines
occurring in the proportion of physically active students (Bray & Born, 2004); the
average number of days students participate in moderate-to-vigorous physical activity
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(MVPA; Kwan, Bray & Martin Ginis, 2009); as well as the average estimated energy
expenditure accrued through leisure-time physical activity (Bray, 2007). Collectively,
this body of evidence points to substantial deteriorations of physical activity among
young adults making the transition into college/university, offering a unique window of
opportunity for intervention.
The transition into university
While college and university students might be viewed at times as just a
convenient sample (Jaffe, 2005), there is compelling evidence that there is an important
public health issue here for physical activity researchers to engage with and intervene on.
First, the transition out of high school is considered to be the first major transition that an
individual faces, representing a stressful time involving numerous aspects of change
(Brooks & Dubois, 1995; Gall et al., 2000; Lafreniere, Ledgerwood, & Docherty, 1997);
secondly, this population represents a sizeable group of young adults facing the unique
challenge in making the transition to higher education; and third, initiation of inactivity
related diseases such as atherosclerosis, obesity, and diabetes are beginning to emerge as
early as the second and third decades of life (Leslie, Sparling, & Owen, 2001). Many
entering college or university are moving away from the stability of home life for the first
time, and require adjustments to independent living (Lafreniere et al., 1997). It may be
the transition itself in not knowing what to expect and how to adapt to a new environment
which ultimately leads to such dramatic decreases in MVPA; therefore, given the new
challenges that these young adults face, it is not difficult to understand how this newly
acquired independence is reflected through changes in physical activity behaviour. In
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line with a developmental perspective on behaviour, the correlates and determinants of
physical activity may also vary across the lifespan.
Efforts to understand some of the life-stage specific correlates and determinants
of physical activity have uncovered some salient psychosocial predictors of physical
activity during the transition to university. There ares compelling data suggesting that the
majority of students enter university with strong intentions to be active throughout their
first-year (Kwan et al., 2009; Kwan & Faulkner, in preparation). In fact, Kwan and
colleagues (2009) found most students enter university with positive attitudes and strong
perceptions of control – both of which are strong predictors of intentions.
Despite the
strong initial desire to be active, however, findings also show that translating those
intentions into behaviour proved difficult.
This again may be reflected by the
aforementioned life changes associated with the transition into university. Ajzen and
Fishbein (1980) suggest that the intention-behaviour relationship tends to decrease in
strength as individuals begin to encounter difficulties with attempting to exert those
intentions. This reasoning is supported by Gyurscik and colleagues (2006), who found
first-year students reporting significantly more physical activity barriers, and of a
different kind, than they faced as high school students. Given the increases in barriers,
students’ confidence to cope with new barriers may be a key factor to target. Coping
self-efficacy has been found to be an important predictor of physical activity behaviours
among the first-year student population, with greater confidence to cope with physical
activity barriers being related to greater engagement in MVPA (Bray, 2007; Gyurcsik et
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al., 2004). Overall, there is theory-based research to inform intervention efforts aimed at
helping students’ physical activity behaviour as they transition into university.
Few attempts, however, have been made to address population-specific
perturbations in social (e.g., peer influence) and environmental (e.g., moving away from
home) conditions.
Currently, Bray and colleagues (2008) have conducted the only
intervention study specifically targeting students’ physical activity during transition into
university. Drawing from some of the social cognitive research among the first-year
student population (e.g., Bray, 2007; Kwan et al., 2009), they developed a physical
activity guide tailored to the first-year university student population. More specifically,
the guide was a brochure designed to reinforce positive self-perceptions around physical
activity, and to stimulate behavioural plans for students to stay active during their firstsemester at university. Overall, the findings from the study were positive in that students
who received the first-year physical activity guide had engaged in more MVPA per week
during their first-semester at university in comparison to students who received a
standard national physical activity guide or no guide.
While Bray and colleagues (2008) have provided a starting point for intervening
with this student population, more effort is necessary to develop more complex
intervention programs aimed at facilitating student engagement – which can potentially
lead to greater results. Print-based material does have several benefits to offer (e.g.,
being low in cost, and easy to mass distribute), however, advanced forms of technology
are becoming salient communication tools that should no longer be ignored. Given the
rapid growth around the Internet, web-based interventions aimed at health behaviour
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change have become increasingly popular (Vandelanotte, Spathonis, Eakin, & Owen,
2007; vandenBurg, Schoones, & Vliet Vieland, 2007; Webb, Joseph, Yardley, & Michie,
2010).
There are a number of reasons why the Internet has great potential for wide-scale
population level interventions. Major advantages of web-based interventions include
participants’ ability to access large amounts of information, participants’ ability to seek
information at any time or as often as they would like, and that the Internet is easily
accessible.
Web-based interventions have the potential to reach all populations,
including sometimes hard-to-reach populations such as older adults, or people with low
levels of educational attainment (Lenhart et al., 2003). However, this reach is markedly
higher within the university student population, as virtually every student has access to
the Internet (e.g., at home, library, school computer labs), and is often a course
requirement. Accessibility aside, web-based interventions are also less time consuming,
less invasive, and more cost effective compared to traditional physical interventions
(Brug, Oenema, Kroeze & Raat, 2005). Internet-delivered interventions may also be
particularly relevant within the context of university students, as recent research has
identified the Internet as being the most frequently used source from which university
students gain health-related information (Kwan, Arbour-Nicitopoulos, & Faulkner, 2010).
Internet-based interventions have demonstrated a varying degree of success for
increasing physical activity behaviours (Brug et al., 2005; Vandelanotte, De
Bourdeaudhuij, Sallis, Spittaels, & Brug, 2005; Vandelanotte et al., 2007; VandenBurg et
al., 2007; Webb et al., 2010). Webb and colleagues recently conducted a systematic
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review around Internet-based interventions targeting health behaviours. While physical
activity interventions were only able to produce a small effect in behaviour change, it
demonstrated the largest effect in terms of magnitude compared to interventions that
targeted other health behaviours (dietary behaviour, alcohol consumption, smoking
abstinence).
A caveat, however, was that many Internet-based interventions were
atheoretical and delivered across broad heterogeneous populations, while many studies
tended to ignore the potential mediating mechanisms underpinning behaviour change.
Intervention effects are markedly improved if theoretically informed; and similarly, are
also more effective if elements of behaviour change techniques are integrated with
personalized contact (i.e., e-mail or text messaging) (vandenBurg et al., 2007; Webb et
al., 2010). Overall, there is evidence to suggest an intervention delivered through the
Internet may be effective in prompting behaviour change – particularly as it relates to the
university student population. It is now necessary to examine the potential feasibility and
efficacy of an internet-based intervention among the target audience, investigating the
receptiveness around an Internet-delivered intervention, and uncovering its impact on
students’ physical activity cognitions and behaviours.
While an eventual goal will be to develop an intervention that can be applied
across the university student population there are several steps required before
implementation and wider dissemination. The Medical Research Council (MRC) has
published recommendations around developing and evaluating complex interventions
(see MRC, 2008). Within these recommendations are various stages of research leading
to efficacy and effectiveness trials, and eventually the implementation of large-scale
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interventions. In particular, there is impetus to first develop an intervention that has a
strong theoretical and practical basis, and to rigorously pilot the intervention. Included in
the piloting process are assessments around the acceptability, usability, feasibility, and
efficacy of the developed intervention. In developing a complex intervention targeting
physical activity decline among the young adults transitioning into university, the MRC
framework provided a useful template to systematically guide the piloting process.
Active Transition – An Internet-based Physical Activity Intervention
A website-delivered intervention, also referred to as Active Transition, was
developed specifically aimed at helping young adults attenuate the declines in physical
activity typically seen during the transition into university. The intervention webpage
was hosted within an institutional portal called “Blackboard”, and developed specifically
to target psychosocial mediating variables based on Ajzen’s (1991) Theory of Planned
Behaviour (TPB) and Bandura’s (1986) Self-Efficacy Theory. While there is increasing
evidence that theoretically-informed interventions aimed at behaviour change are more
effective than atheoretical approaches (Baranowski et al., 1998; vandenBerg et al., 2007),
recent evidence also suggests Internet-based interventions based on around the TPB led
to substantially larger effects than other theory-based interventions (e.g., social cognitive
theory, transtheoretical model) (Webb et al., 2010). The intervention also targeted selfefficacy theory because confidence to cope with physical activity barriers is an important
aspect of physical activity maintenance in this population. Overall, both TPB and selfefficacy theory share the tenet that physical activity change is mediated by the interaction
between individual, social, and environmental factors (Lox et al., 2006). Therefore,
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Active Transition focused around delivering informational content that targeted
university students’ behavioural, normative, and control beliefs around physical activity,
while helping students become more confident in their ability to act on positive intentions
to be physically active. Printable intervention content is provided in Appendix C.1.
Durations of physical activity interventions are typically 6 weeks or greater (Kahn
et al., 2002), thus, Active Transition was designed to be a 6-week pilot intervention
highlighted by a series of weekly topics/modules around physical activity motivation,
action, and maintenance. Weekly topic was accessible at any point via a toolbar link;
however, the homepage (the page in which individuals were directed to when accessing
the website) was updated each week to reflect a new physical activity-related topic. An
example screenshot of the intervention website is presented in Figure 1. In an effort to
increase students’ physical activity motivation (e.g., attitudes, perceptions of control),
topics at weeks 1 and 2 were primarily around education and awareness-raising (e.g.,
student-specific benefits associated with physical activity, presenting the common
barriers that students encounter at university, and the corresponding coping strategies to
deal with these barriers.).
In an attempt to bridge the gap between intentions and
behaviour, the intervention topics at weeks 3 and 4 shifted in focus to behavioural
modification techniques.
More specifically, Active Transition included information
around implementation intentions and goal setting, which are two strategies that have
been found to be effective in translating people’s intention into behaviours (Ajzen, 2006;
Gollwitzer, 1999; Smith, Hauenstein & Buchanan, 1996).
Weeks 5 and 6 of the
intervention focused on topics related to relapse prevention and behavioural maintenance.
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Perceptions underlying behavioural maintenance often differ than adopting new
behaviours like physical activity (Rothman, 2000); therefore, the idea was to encourage
and provide students with the tools necessary to recover their physical activity behaviours
despite abruptions which may occur intermittently over the course of a university
semester. Students were provided with resources and encouragement to maintain a
physically active lifestyle despite the rigors associated with university life. A description
of weekly topics is shown in Table 1.
In addition to the weekly topics which aimed more at individual-level factors,
Active Transition also provided salient information as it relates to the broader contexts of
the social and environmental factors. Specifically, the intervention website attempted to
facilitate greater social networking through a number of interactive discussion
boards/forums, where students were able to seek out students interested in organizing or
engaging in physical activities.
Furthermore, students were also provided with an
opportunity to consult with a physical activity expert in regards to anything related to
physical activity participation. Understanding that the transition into university is also
associated with changes in the environment, an environmental scan was conducted,
providing students with information and links to opportunities to be active in or around
campus. This information included links to the institutional athletic facilities, sport and
social clubs nearby, as well as a number of mapped running and cycling routes.
Study Purpose
The current investigation was a 3-phased pilot study. An overall summary of the
three phases is shown in Table 2. The first purpose of the study was to determine the
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feasibility in implementing website-delivered physical activity intervention among the
university student population. More specifically, feasibility investigated the acceptability
of the website-delivered intervention, and to examine its usability. The second purpose
was to conduct an efficacy trial to examine the specific impact of the 6-week physical
activity intervention on students’ physical activity behaviours and cognitions. The final
purpose of the study was to provide participant feedback around the website-delivered
physical activity intervention, and to provide recommendations for future intervention
efforts.
In summary, a website-delivered intervention was developed to specifically target
physical activity decline through social cognitive mediators related to physical activity
behaviours. It was expected that the intervention would be feasible, in terms of university
students’ acceptance, usability, and its implementation within a university residence.
With respects to intervention impact, it was hypothesized that students assigned to an
intervention condition would be able to better sustain their physical activity behaviours
(defined as weekly MVPA) compared to students assigned to a comparison group.
Likewise, it was also hypothesized that students assigned to the intervention condition
would also exhibit more stability in their physical activity cognitions (e.g., attitudes,
perceived behavioural control, confidence in physical activity maintenance). Given that
this was a pilot study of a newly developed intervention, it is expected that the
intervention will require enhancements and changes for future intervention work.
Therefore, formative feedback from participants in the intervention will be important for
facilitating improvements in future intervention efforts.
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PHASE I – USABILITY AND ACCEPTABILITY TESTING
Methods
Phase one of the pilot study was conducted in order to confirm that a newly
developed intervention website targeting the university student population was
comprehensive in scope and relevant to the audience. Currently, there are no established
theories or model on how to measure the acceptability or feasibility of tailored
interventions; however, there are themes that consistently emerge in the literature which
are assumed to be important in pre-testing the intervention materials. For example,
previous studies have focused their feasibility testing around intervention usability, userfriendliness, credibility, comprehensibility, and readability (Cousineau, Franko,
Ciccazzo, Goldstein, & Rosenthal, 2006; Kreuter, Farrell, Olevitch, & Brennam, 2000;
Vandelanotte & Bourdeauhuij, 2003). In short, feasibility testing was used as a mean to
demonstrate concept viability. Therefore, the first phase examined Active Transition to
determine if: (1) the content within the website intervention was comprehensive,
interesting, and potentially effective in preventing declines in physical activity
behaviours upon entry into university – acceptability testing; and (2) if students found the
intervention website user-friendly – usability testing. A total of 15 first-year university
student and 7 physical activity experts participated in this phase of the pilot study.
Student that provided consent took part in both the acceptance testing and usability
testing (see Appendix C.2), while the physical activity experts only participated in the
acceptance testing.
Procedures
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Acceptance Testing – After navigating through the entire intervention website,
participants were given a questionnaire to complete. Using a 17-item questionnaire
adapted by Vandelanotte and Bourdeauhuij (2003), participants rated their acceptance
and satisfaction around the web-based format, physical activity advice, content targeted
to university students, and overall usefulness of the information. For example, a question
pertaining to the web-based format asked participants, “Overall, I found the web-based
format to be informative”. Other questions also asked whether the web-based format was
appropriate in tone and language, graphically appealing, and if it was easy to navigate.
Questions around physical activity advice asked: “I think the physical activity advice was
interesting”, as well as if the physical activity advice was credible, personally relevant or
useful, logical, comprehensible, well-styled, complete, instructive, appropriate in length,
straight forward, and if it provided sufficient amounts of information. There were two
global items that asked: “The website’s content was clearly targeting university students”
and “Overall, I think the website could be useful for helping me be physically active”. All
items were scores on a 7-point Likert scale (1= Strongly disagree to 7= Strongly agree).
Consistent with Cousineau and colleagues (2006), an acceptability criterion of 80% was
established (i.e., on average 80% of end users would rate their satisfaction with each of
the subscales in the good-excellent range, 5-7 on Likert scale). In addition to the items
above, suggestions for enhancements, deletions, and additions were also solicited
(Appendix C.3).
Usability Testing – A traditional usability methodology was used (Nielsen
NetRatings, 2002).
Using a desktop computer, each of the students were asked to
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complete seven navigational tasks on the intervention website (e.g., post a message on the
discussion board, access an example on how to action plan; see Appendix C.4). A silent
observer noted areas of difficulty and confusions. As a crosscheck of the observer’s
observation of the students’ performance, students were also asked to rate the difficulty
of each task after they completed them (1= very easy to 7= very difficult). Similarly to
Cousineau and colleagues (2006), an evaluation criteria of 80% was established (80% of
students would be able to successfully complete at least five of the seven tasks without
assistance).
Results
Overall, the results of phase one of the pilot study were positive. University
students and experts alike gave the intervention website high acceptability ratings across
the web-based format, physical activity advice, content targeted to university students,
and overall usefulness of the information. The results indicated that the participants met
the acceptability criterion, with each participant scoring between 5-to-7 on each of
subscales. More specifically, participants reported a high degree of satisfaction around
features of the website, with positive responses around the web-based format (M= 6.57),
and the physical activity advice provided (M= 6.25). Perhaps most importantly, the
results also provided confidence that the intervention was appropriately targeting the
university student population (M= 6.10), and that the intervention would be useful in
terms of helping students be physically active (M= 6.40). In the solicitation for additions,
deletions, and enhancements to the intervention website, a number of minor changes were
suggested. For example, a participant wrote: “The fonts within the action planning page
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is different at the top to the bottom, it would be better if it was all the same…”. In
general, the suggestions were primarily around the aesthetics of the various pages within
the website, whether it be changes to font size colours, or requests for additional images.
The results of the usability test suggested that the intervention website was userfriendly, and that students had little difficulty with the navigational tasks. No request for
help were made by the participants, and the website was rated high on usability (M=
6.21).
Overall, in an effort to enhance the intervention website and its potential
effectiveness, a few minor changes to the intervention website were made as a result of
this pre-testing phase.
These minor changes included font adjustments, changes to
pictures, and concision to some text within the intervention website.
PHASE II – EFFICACY TRIAL
Methods
Participants and Procedures
Stratified cluster randomization was used to recruit participants for this quasiexperimental trial.
Two university residences were chosen to participate in the
intervention trial. Within each of two participating residences, two floors were randomly
drawn and assigned to the intervention condition or comparison condition. During the
early part of the autumn semester (September 2009), students on each of the participating
residence were invited to take part in the Active Transition pilot study.
Contact
information and written consent was obtained for the students interested in participating
(see Appendix C.5). During the following week, all interested participants were sent an
email message that contained a secure link to the baseline questionnaire. The baseline
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questionnaire (Appendix C.6) included information on demographic characteristics as
well as baseline measures of their physical activity behaviour (past 8 months MVPA),
and four physical activity cognitions (attitudes, subjective norm, perceived behavioural
control, & intentions).
Follow-up measures were obtained six weeks later (Appendix C.7). Students
were again sent an email message with a link to the follow-up questionnaire. The followup questionnaire had measures of their physical activity behaviour (past 6 weeks MVPA),
the same physical activity cognitions questions at baseline (attitudes, subjective norms,
perceived behavioural control, & intentions), as well as the recovery self-efficacy scale.
The study was approved by the University of Toronto Research Ethics Board, and all
participants provided informed consent prior to completion of the baseline survey.
Participants were entered in a draw for one of four $25 gift certificates contingent upon
their completion of the follow-up survey.
The final sample size for the efficacy trial was 65. A comprehensive breakdown
of participant responses is shown in Figure 2.
Of the 198 students living in the
residences, 74% of those students (n = 146) expressed interest in taking part in the study
and provided both their contact information and written consent. Baseline data was
obtained from 91 (n = 59 females) of the 146 students who were contacted and provided a
link to the baseline questionnaire, representing a 62% response rate. Of the original
sample that completed the baseline questionnaire, 65 completed the follow-up
questionnaire (n = 44 females), representing a 71% retention rate. Despite participant
attrition, there were similar gender and experimental group proportionalities between
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baseline and follow-up. One-way ANOVAs revealed no significant differences between
adherers and dropouts for baseline physical activity levels (F (1, 89) = 1.67, p >.05), or
on any of the physical activity cognition measures (p’s >.05), thus the final sample of 65
participants was used for subsequent analyses.
Study Conditions
Active Transition as the intervention consisted of two primary intervention
delivery components. The first was the webpage itself – as described earlier – and was
accessible to students at any time throughout the 6-week intervention period. The second
component pertained to the weekly highlights. In addition to the weekly updates on the
website homepage, weekly highlights were also delivered to participants in the
intervention condition via e-mail. This e-mail contained a short synopsis around the
weekly topic, and a link to the intervention website’s homepage during each of the six
intervention weeks. To illustrate the process, the following is an example of week 2. To
put this in context, the primary purpose was around informing students of ‘studentspecific’ benefits associated with being physically active [e.g., physically active students
tend to have greater GPAs), specifically targeting university students’ motivation and
attitudes around physical activity.
First, an e-mail was sent to the students along the lines of: “Hope you are having
a great week… Did you know? Being physically active can help you obtain better grades.
Physical activity can give you more energy, allow you to concentrate better, and will get
you a better nights rest! Find out more about how physical activity can help you with
your studies and more…” An external link to the webpage also accompanied the e-mail
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message. This link sent them to the homepage, which was updated each week to reflect
each of the weekly topics. So for week 2, information around the ‘student-specific’
benefits of physical activity was put on the intervention homepage.
There was a
concerted effort to limit the amount of text (so the webpage is less overwhelming), thus
only a few highlighted points were included on these actual pages. However, to provide
students with more in-depth information around the student-specific benefits of physical
activity, one-page corresponding brochures were also developed (see Figure 3). To access
these brochures, students would click on its corresponding icon, which presented
information on how physical activity is related to increased energy, weight management,
improved social life, and its health benefits. While the preceding was an illustration of
one particular week, the process was replicated over the 6-week intervention on the topics
of x, y, and z.
Intervention Condition: Participants in the intervention condition were given
entry into the access-controlled intervention website. This access enabled students to
enter the intervention website at any point throughout the 6-week intervention.
In
addition to access to the webpage, participants in the intervention condition also the
received weekly e-mails prompts containing a brief description around the weekly
highlights, and a link to the website (as described earlier).
Comparison Condition: Given that this was a pilot study in the early stages of
development, and for pragmatic reasons, a true control group was not selected. In
identifying sites for the research, residence organizers made it clear that intervention
materials should be made available to all students at the participating residences. Given
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that the intervention material was tailored for students as they first enter the fall semester,
a waitlist control group was not an option. Alternatively, a comparison condition was
chosen to provide students with access to the information within the intervention website.
However, because the effectiveness of Internet-based interventions is greatly enhanced
with the use of additional methods of interacting with participants – especially text or
email messages (Webb et al., 2010) – participants in the comparison condition were
provided entry into the access-controlled intervention website, but did not receive any emails or further prompts to enter the intervention website. Overall, this condition was
assumed to be a minimal-contact intervention, and it was expected that there would be
little engagement among participants in this condition.
Measures
Moderate-Vigorous Physical Activity. The moderate and vigorous activity
sections of the 2003 Behavior Risk Factor Surveillance System (BRFSS; CDC, 2003)
interview schedule were used to assess MVPA. Participants reported the average number
of sessions of moderate and vigorous physical activity engaged in per week as well as the
average duration of each moderate and vigorous activity session in response to the
following questions: (1) In a usual week, how many DAYS do you do vigorous activities
(such as running, aerobics, hockey, squash) for at least 10 minutes at a time that cause
large increases in breathing or heart rate?, (2) On days that you do vigorous activities
for at least 10 minutes at a time, how much total time per day do you spend doing these
activities?, (3) In a usual week, how many DAYS do you do moderate intensity activities
(such as brisk walking, bicycling, easy swimming, volleyball) for at least 10 minutes at a
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time that cause moderate increases in breathing or heart rate? (4) On days that you do
moderate activities for at least 10 minutes at a time, how much total time per day do you
spend doing these activities?
For baseline physical activity, participants completed the measure by indicating
the average number of days per week they performed moderate-intensity activities and
vigorous-intensity activities and for how long, on average, they performed the activities
on those days with specific reference to the 8-months prior. For example, a student might
have engaged in vigorous-intensity activities on an average of 2 days per week for 40
minutes on each occasion and moderate-intensity activities on 3 days per week for 20
minutes on each occasion. A total score representing moderate-vigorous activity was
computed by adding the products of the average weekly frequency and duration for each
of the moderate and vigorous intensity activities. In the example above, the total score
for moderate-vigorous activity would be 140 minutes. Consistent with previous studies
examining physical activity during students’ transition into university (e.g., Bray & Born,
2004; Kwan et al., 2009), an 8 month period captures the average physical activity
including during students’ previous academic semester.
The follow-up measure of
physical activity was an identical set of BRFSS questions with specific reference to the
previous 6 weeks – representing their physical activity during their current academic
semester.
Social Cognitive Variables. The social cognitive variables chosen comprised of
measures consistent with the TPB, and used in previous physical activity research (e.g.,
Kwan et al., 2009). Questions from the TPB as well as an additional measure of recovery
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self-efficacy were chosen because the Active Transition was developed specifically
targeting these psychosocial variables. For the purposes of clarity and consistency,
physical activity cognitions assessed by TPB measures all used the common definition
pertaining to being “physically active”, which was defined as engaging in activities of a
moderate or vigorous intensity on most days (i.e., > 4 days) per week for at least 30
minutes per day (in accordance with Public Health Agency of Canada guidelines).
Participants were asked to use this common definition when answering all TPB
questions.
Attitudes. Attitudes for being physically active were measured using six items.
Two items captured the instrumental component, represented by: harmful/beneficial and
useless/useful.
Three items represented the experiential component with questions
anchored by: enjoyable/unenjoyable, pleasant/unpleasant, and fun/boring. The final item
was a good-bad scale, which in past research has captured the overall evaluation of
behaviour very well (Ajzen, 2002). Each of the items contained the following stem
statement: “Being physically active for me will be…” Participants rated each of the
items on a 7-point Likert scale. The scores were summed with higher scores representing
more positive attitudes about being physically active. Cronbach’s alpha for the scale was
( = .87) at baseline and ( = .83) at follow-up.
Subjective Norms. A single item was used to reflect subjective norms. The item
was a general question asking: “Important people to me think I should be physically
active...” Participants were required to rate each item on a 7-point Likert scale anchored
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by 1= Strongly disagree/7= Strongly agree, with a higher score representing greater
perception of social approval towards being physically active.
Six items were used as the measure for
Perceived Behavioural Control.
perceived behavioural control (PBC), with three questions assessing controllability and
three questions assessing self-efficacy.
For example, questions pertaining to
controllability include: “how much control do you have to be physically active…” (1=
Extreme lack of control/7= Extreme control), and questions assessing the self-efficacy
include: “how confident are you that you can be physically active…” (1= Extremely
unconfident/7= Extremely confident). Scale items were subsequently summed, with
higher values representing greater perceived behavioural control to be physically active.
Cronbach’s alpha for the scale was ( = .78) at baseline and ( = .76) at follow-up.
Physical Activity Intentions. Three items were used to measure participants’
intentions to be physically active. Each question was anchored by 1= Strongly
disagree/7= Strongly agree, asking “I intend to be physically active…”, “I will try to be
physically active…”, and “It is my desire to be physically active…”. Scores for the three
questions were summed with higher values representing stronger intentions to be
physically active. Cronbach’s alpha for the scale was ( = .93) at baseline and ( = .91)
at follow-up.
Recovery Self-efficacy. This single item measure of recovery self-efficacy was
adapted from a measure used in previous research (Luszczynska, Mazurkiewicz,
Ziegelmann, & Schwarzer, 2007). While the original sample was developed specifically
for runners, adaptations were made to reflect the context of the university environment.
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The question was anchored by “1= Not confident at all” and “10= Completely confident”,
asking: “How confident are you to be able to continue your regular physical activity
routines following periods of disruptions and increased workloads (e.g., weeks that you
are less active due to exams and/or reading breaks)?”.
Results
Demographic characteristics of the overall sample, segmented by study conditions
are presented in Table 3. As a part of the process evaluation, data was obtained to
determine participants’ engagement with the intervention website.
Usage statistics
indicated that only 47% of students in the intervention condition were considered users
(represented by participants who visited the website on 2 or more occasions), while 41%
of the students in the comparison condition were considered to be users. Overall, the
results showed that total compliance was low, with only 4 participants entering the
website on 6 or more occasions during the 6-week intervention period, and 25
participants entering the webpage between 2 to 5 times. A complete breakdown of the
users and non-users within each of the study conditions is shown in Figure 5.
Physical Activity Behaviour
MVPA levels are presented in Table 4 and displayed graphically in Figure 6.
Overall, minutes of MVPA prior to the intervention were relatively high among the
students irrespective of study conditions, reporting nearly 10 hours of MVPA per week.
Univariate analysis of variance (ANOVA) confirmed that there were no significant
differences in baseline MVPA between intervention and comparison conditions (F (1,64)
= 0.00, p > .05).
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A repeated measures ANOVA was used to examine the changes in physical
activity behaviours between intervention and comparison conditions. The results found a
significant main effect for MVPA, (F (1,64) = 32.08, p < .01, p2= .20 ); however, the
interaction between MVPA and intervention condition was not statistically significant, (F
(1,64) = 0.48, p = .49, p2= .01). Overall, there was a significant decline in MVPA for
students in both the intervention (594 minutes per week to 393 minutes per week) and
comparison conditions (595 minutes per week to 330 minutes per week). The descriptive
statistics show MVPA at follow-up being higher among participants in the intervention
condition; however, these differences were not statistically significant.
Targeted Mediating Variables
Descriptive statistics for the social cognitive variables measured are presented in
Table 4, and results are shown graphically in Figures 7 to 11. Differences among the
TPB variables were evaluated using multiple repeated measures ANOVAs, and
univariate ANOVA was used to examine differences in recovery self-efficacy. The
results found significant declines in students’ attitudes (F(1, 63) = 59.83, p <.01, p2=
.49), perceived behavioural control (F(1, 63) = 21.24, p <.01, p2= .26), and intentions
(F(1, 63) = 5.40, p <.05, p2= .08). However, only the interaction between intentions and
intervention conditions was statistically significant (F(1, 63) = 6.91, p< .05, p2= .10);
although the interaction between PBC and intervention conditions was approaching
significance with a medium effect size (F(1, 63) = 3.73, p= .06, p2= .06). There were no
significant main effects for subjective norms (F(1, 63) = 0.02, p = .96, p2= .00); and no
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significant differences between intervention conditions in participants’ reported recovery
self-efficacy (F(1, 51) = 0.17, p = .68, p2= .00).
Ancillary analyses
Overall, usage statistics indicated that there was low student engagement with the
intervention website, and that there was some cross-contamination between conditions.
More specifically, there were participants that were assigned in the intervention condition
who were non-users of the intervention (logged in ≤ 1 time); and conversely, there were
participants in the comparison condition who were considered to be regular users (logged
in ≥ 2 times). Therefore, post-hoc analyses were conducted to compare only the users of
the intervention to non-users within the comparison group. This provides an additional
comparison of interventions individuals who used the website more often versus those
comparison group individuals with no or minimal contact with the website. The results
indicated that physical activity increased from 458 minutes of MVPA per week at
baseline to 474 minutes of MVPA per week following the intervention for users of the
intervention. Physical activity decreased from 546 minutes of MVPA per week to 424
minutes of MVPA per week among non-users in the comparison condition. However,
neither the main effect for physical activity (F(1,32) = 0.37, p = .55, p2= .01), or its
interaction was statistically significant (F(1,32) = 0.63, p = .43, p2= .02).
In the comparisons of physical activity cognitions, significant main effects were
found for attitudes (F(1, 32) = 29.45, p< .01, p2= .48), perceived behavioural control
F(1, 32) = 20.84, p< .01, p2= .40), and intentions (F(1, 32) = 4.24, p< .051, p2= .12).
There was also a significant interaction between intervention conditions and attitudes
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(F(1, 32) = 4.14, p= .05, p2= .12), perceived behavioural control (F(1, 32) = 12.97, p<
.01, p2= .30) and intentions (F(1, 32) = 7.06, p< .05, p2= .19). That is, users in the
intervention condition exhibited significant attenuations in the declines in attitudes,
perceived behavioural control and intentions.
The interaction between intervention
conditions and subjective norms was not significant (F(1, 32) = 0.07, p= .79, p2= .00).
Despite intervention users reporting greater confidence to be active following a period of
disruption, the results indicated that the differences in recovery self-efficacy was not
significantly significant (F(1, 32) = 1.20, p = .28, p2= .04).
Intention to treat analysis
Intention to treat analyses were included to provide a conservative estimate in the
effects, which can be overinflated due to biases of participant drop-out (vanderBurg et
al., 2007). There is no consensus in how missing responses should be handled within an
intention to treat analysis (Hollis & Campbell, 1999), thus, two approaches were taken.
The first approach was the more conservative, imputing participants’ baseline scores into
missing follow-up scores (i.e., assuming no change between baseline and follow-up).
The second approach was more liberal, in computing the average change scores among
the completers for baseline scores of the non-completers. For example, MVPA declined
an average of 228.04 minutes per week among the final sample (N = 65). This average
MVPA decline was subtracted from non-completers baseline MVPA, thus reflecting an
average rate of change.
The only exceptions were cases where the calculated values
were less than zero, in which case a zero was assigned. Both intention to treat analyses
yielded similar results; therefore the statistics from the conservative approach will be
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presented. Overall, there was little change in terms of intervention effect between the
previous analyses and the intention to treat analysis. Significant main effects were still
evident for MVPA (F(1, 89) = 14.68, p< .01, p2= .14), attitudes (F(1, 89) = 48.25, p<
.01, p2= .35), perceived behavioural control (F(1, 89) = 19.71, p< .01, p2= .18), and
intentions (F(1, 89) = 2.85, p< .05, p2= .06); while the interaction between intervention
condition and intentions (F(1, 89) = 3.66, p< .01, p2= .07) was the only statistically
significant interaction.
PHASE III – POST-INTERVENTION FORMATIVE EVALUATION
Methods
Participants
A total of 11 participants took part in the post-intervention focus groups. Eligible
participants had to satisfy a number of criteria, including: (1) being a participant in the
efficacy trial; (2) having entered the web portal at least once during the 6-week
intervention period; and (3) were willing to share their thoughts and provide feedback.
Participants were recruited through e-mail. Students who responded were first screened
to ensure that they met the study’s selection criteria, and then subsequently assigned to
one of two focus groups. Each focus group session was approximately 45 to 55 minutes
in duration.
Focus Group Overview
Since the focus groups were designed to be exploratory by nature, a semistructured interview schedule with general questions and subject areas were used to guide
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the focus group.
These subject areas included questions regarding the general
impression, accessibility, content, and possible improvements related to Active
Transition. The interview schedule is presented in Appendix C.8. Focus groups were
audio-recorded, transcribed, and a thematic analysis was carried out in which the data
were analyzed inductively (Braun & Clarke, 2006).
Results
The purpose of the third phase within the current pilot investigation was to obtain
participant feedback on Active Transition, providing suggestions and recommendations
for improvements towards future intervention efforts.
In the discussion on general
impressions, it was clear that students had positive evaluations pertaining to the concept
of Active Transition. More specifically, all the focus group participants thought that the
intervention website was a good idea, and perceived that it was a useful initiative for
helping students during their transition into university. Karen states: “You know, I like
the idea… I think its [physical activity] really important and with just how school stuff
is, I like the website having the stuff on there to help (Karen).” Similarly, students
discussed how the information was useful, and was applicable within the context of the
university environment.
Despite positive feedback related to the intervention concept, however,
participants did have a number of criticisms towards Active Transition, particularly with
the use of portal Blackboard. Some of the students indicated that there were times that
the link to Active Transition was not easily accessible, where the link to the intervention
website became lost among other competing Blackboard communities. Other students
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like Stacey found problems related to the webpage format, where some pages had
different fonts, and some pictures being distorted depending on the computer that was
used. “I think each page should have consistency. I didn’t get a sense that each one went
together because they all looked different, I think you should have the top of the pages
like the AC has on theirs… although I know that website sucks (Stacey).” Interestingly,
students appeared aware of the limitations associated with Blackboard, and did have an
appreciation for the difficulties associated with making a Blackboard community
aesthetically appealing. John empathizes, “Some things you just can’t control and I know
that Blackboard won’t let you do some things on it, and there is only so much you can do
on it (John).” Overall, if Active Transition were to be re-developed, students suggested
that the website should have greater commonality between each of the pages (i.e., having
consistent fonts, webpage banner).
However, given the limitations associated with
Blackboard, some of the students also felt that it would be beneficial to develop Active
Transition using a different web-based platform – including developing its own website
or using popular social networking sites such as Facebook.
Overall, the efficacy trial found the usage of Active Transition to be lower than
anticipated. Therefore, it was important to explore issues around student engagement,
and how Active Transition can be made to improve usage among the student population.
However, the results found students having difficulty with providing suggestions on how
to get students more engaged with the intervention website.
While some students
suggested that features such as participant feedback (i.e., physical activity tracker) could
be beneficial, it seemed that the majority of the students conceded that there was
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ambivalence when it came to engaging in extra-curricular activities, and that there was no
clear answer for low participation rates. Kevin states: “The problem is that there is so
much going on… I think we all agree here that we should be doing more exercise and
stuff, and I mean it’s fun and all, but I just don’t know how you can get people on here…
maybe if you offer them free food or something… (Kevin).”
Overall, the focus group
findings were positive in terms of the acceptability of Active Transition, but there were
several suggestions to make the website itself more appealing. Despite participation rates
being lower than expected, it is still unclear how student engagement can be increased,
and future work needs to explore how a website-delivered intervention can be made more
engaging among the university student population.
Discussion
The aim of the present study was to explore issues of feasibility, and to examine
the potential effect of a newly developed website-delivered intervention in attenuating
declines in students’ MVPA through the targeting of physical activity cognitions.
Overall, it appears that an Active Transition was not only acceptable to the target
audience, but also user-friendly. The Internet itself also appears to be a feasible option
for the delivery of a physical activity intervention to university students, as Active
Transition was implemented across a cohort of students living within one of two
university residences. While the response rate was relatively low, the retention rate was
much stronger than previous studies with this population (e.g, Kwan & Bray, 2006; Kwan
et al., 2009). In terms of impact, the intervention demonstrated some success in changing
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physical activity cognitions although there was no discernible effect on physical activity
behaviour.
Study Feasibility
The pre-testing phase of this pilot investigation demonstrated the acceptability
and usability of Active Transition. The results suggest that the intervention website itself
was developed in a user-friendly manner, and that the content within was informative,
and would be beneficial to the university student population. In terms of implementation
of Active Transition, among the total number of students who were eligible to take part in
the efficacy trial, 74% of the students expressed interest (i.e., written consent) to
participate in Active Transition. Given that there were students who were unable to
attend the orientation, the results indicated that they had initial interest at the start of the
semester. However, of those who did express that early interest, only 63% completed the
baseline questionnaire and 71% of those completed the follow-up questionnaire. Overall,
it appears that students were accepting of the concept of a physical activity intervention,
but their interest in participating in the study tapered off when students were asked to
complete questionnaires.
Broadly speaking, the implementation of a website-delivered physical activity
such as Active Transition appears feasible; however, participant non-compliance was a
concern. The results of the study found only 45% of the students to be active users of the
intervention, despite using a liberal approach to categorize intervention usage (i.e.,
logged into Active Transition on > 2 occasions). Active Transition was developed as a 6week long intervention, ideally having students accessing the webpage on a weekly basis
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– which only 6% of participants complied with.
This is consistent with formative
research that suggests students are ambivalent towards their decline in physical activity
(Kwan & Faulkner, in preparation). In general, students perceive physical activity to be
important; likewise, had positive perceptions around a physical activity intervention.
However, the results of the current study suggest that while there may have been initial
interest in the idea of physical activity promotion, students were less keen on engaging
with the intervention on a regular basis.
Similar sentiments emerged in the post-
intervention focus groups. Although the concept of Active Transition was perceived as a
great idea, students were unsure of how to improve the intervention, and how to get other
students more engaged with an Internet-based intervention. Overall, more research may
be needed to understand how an intervention can be developed to overcome this issue of
student ambivalence.
Increasing student engagement appears particularly important
given the results from the efficacy trial, which found significant attenuations in key
physical activity cognitions for those students who had engaged in the intervention.
Impact from Active Transition
Consistent with previous research (Bray & Born, 2004; Bray & Kwan, 2006;
Kwan et al., 2009), MVPA levels declined markedly across both study conditions
between baseline and follow-up.
In terms of intervention effects, there were no
significant interactions between MVPA and intervention condition (intervention versus
comparison), even after accounting for the usage among intervention conditions. Posthoc analyses indicated that physical activity behaviours increased slightly among users of
the intervention website; however the finding suggests that no differences in physical
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activity change occurring between intervention conditions. However, we caution that
these results should be interpreted within the context of an efficacy trial. Upon closer
examination, students assigned to the intervention condition reported engaging in
approximately 60 more minutes per week of MVPA than students in the control
condition.
While this difference was not statistically significant, this extra hour of
MVPA per week may have some clinical significance particularly if maintained over
time. Future research is required to confirm whether these differences in physical activity
behaviours are a true effect.
While there is argument for its clinical relevance, there is one plausible reason for
why the decline in physical activity was not attenuated. Active Transition aimed to
attenuate declines in physical activity through salient psychosocial mediators.
Specifically, because the intervention itself was targeting the key mediating variables,
MacKinnon (2008) would suggest that this could delay the effect on the behavioural
outcome measures. In other words, the six-week length of the intervention was too short
to see meaningful differences in behaviour manifest themselves.
Overall, consistent with previous research using TPB measures, participants
reported relatively high baseline scores across all physical activity cognition measures
(Kwan et al., 2009); however, students’ attitudes towards physical activity, perception of
control, and intentions all significantly decreased during the 6-week intervention period.
While the declines in attitudes were surprising, the declines around perceptions of control
are easier to understand. University students, particularly those in their first-year, enter a
volatile period requiring constant adjustments.
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correction to reflect the adaptation to the university environment. Given the evidence to
suggest that students encountered more barriers to physical activity at university
compared to at high school (Gyurcsik et al., 2004; Kwan & Faulkner, in preparation), our
results may be indicating that students may have been overly optimistic in the early
stages of the semester and overestimated their perceptions of control.
Considering that Active Transition was targeting psychosocial mediators, there
were some positive results. There was some indication that the intervention attenuated
declines in their perceptions of control; which in turn may have important implications in
terms of attenuating the declines in physical activity behaviours over time. Perceived
behavioural control is posited to reflect both controllability and self-efficacy (Ajzen,
1991). While empirical evidence suggests that students who are more efficacious to cope
with barriers tend to be the students who can sustain their physical activity levels (e.g.,
Bray, 2007), perceived control may be equally important given the novel environment
that students are entering.
The findings also revealed a significant interaction between intentions and the
intervention conditions, meaning participants in the intervention condition demonstrated
significant attenuations in declines in physical activity intentions. Maintaining strong
intentions to be active is important because it is considered to be the most proximal
determinant of behaviour (Ajzen, 1991). In terms of students’ attitudes, it was somewhat
disappointing that no significant interactions emerged between intervention and
comparison conditions.
The findings may suggest that the intervention might need
modification to better target students’ evaluations around physical activity. However,
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subsequent analyses comparing users of the intervention and non-users in the comparison
condition did indicate that Active Transition could be effective in attenuating the declines
in attitudes if they receive a certain dose of the intervention.
Strengths and Limitations
While the findings of the current study are promising, there are several limitations
to acknowledge.
One limitation of this study was the small sample size recruited.
However, it should be noted that the purpose of the current investigation was to pilot a
newly developed intervention, thus formal power calculations were not conducted.
Another limitation was that the physical activity data was self-reported increasing the
susceptibility to errors based on recall and social desirability. It is noteworthy, however,
that the BRFSS has demonstrated good reliability in the past, and measurement error
should be equally distributed among the sample population (Brown, Trost, Bauman,
Mummery, & Owen, 2004), thus, the data should be reflective of the general differences
between groups in MVPA scores. Finally, because this was a pilot study, the study
design had a short follow-up period, and did not include a control condition. Given that
the intervention effects were based on comparisons between students who had the same
access to the information, the findings of the current study may have been conservative;
and it is unknown whether those effects can be sustained throughout a students’ academic
year.
While there were some limitations, there are several strengths of this study worth
highlighting.
First, Active Transition was a theoretically-informed intervention,
incorporating elements aimed at increasing physical activity motivation, adaptation and
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behavioural maintenance. The content was specifically tailored to the university student
population, presenting students with relevant information pertaining to their university
experiences drawing on formative focus-group research (Kwan & Faulkner, in
preparation). Another strength for this study was the use of the Internet as the delivery
vehicle for the intervention. In particular, the intervention utilizes an institutional portal,
which every student within the institution would have access to, and is commonly used at
Canadian universities. Accordingly, the intervention has high potential for later adoption
and diffusion. While the results of this study are promising, more investigations around
the intervention are warranted. More specifically, given the scope of this pilot study,
larger efficacy trials with the inclusion of true control groups (i.e., conditions that do not
receive any intervention information) are needed.
Furthermore, future research also
needs to examine physical activity behaviours and physical activity cognitions over a
longer period of time. A future efficacy trial using a larger sample and a longer followup period will enable greater opportunities to model behaviour change, as well as allow
for appropriate testing of mediation.
This will be an important step before the
implementation of a population-level physical activity intervention for university
students.
Conclusion
The current pilot study demonstrated the feasibility and effects of a newly
developed website-delivered physical activity intervention among a group of university
residence students. Active Transition was considered to be acceptable and easily usable
among the target population, and feasible to implement. Results from the efficacy trial
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highlight the significant declines in physical activity and the lack of stability in students’
physical activity cognitions during the early stages at university. While some evidence
points to attenuation in physical activity decline, Active Transition was successful in
attenuating some declines in students’ physical activity cognitions. Overall, this pilot
study suggest that we are able to intervene at this critical life stage with some tentative
evidence from the ancillary analyses that declines in physical activity can be attenuated.
The use of a website-delivered physical activity intervention appears promising, although
student engagement and participant compliance could be improved.
Research must
continue to develop innovative strategies for encouraging university students to maintain
a physically active lifestyle that can be sustained through young adulthood and beyond.
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Ph.D. Dissertation – M. Kwan
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Table 1
Synopsis of the Weekly Intervention Topics.
Weeks
(targets)
1
Weekly Intervention Topics
The first week was primarily an introduction to Active Transition. In addition to receiving
general information on Health Canada guidelines for being physically active, students were
provided with quick tips on how they can be active throughout the day, and a brief overview of
the intervention website. This information included: instructions discussion boards and
calendars; links to various on and off campus activities; and an introduction of the physical
activity expert who was available to answer student questions.
2
The second week targeted the attitudinal component of the intervention, highlighting the studentspecific benefits around being physically active. Students were presented with physical activity
trends among student’s entering university, and information on how physical activity specifically
impacts student life. The student-specific benefits highlighted included: increasing energy, weight
management, improving social life, and health benefits.
3
The focus of week three shifted to the physical activity barriers, targeting students’ perceived
behavioural control. Unanticipated difficulties appear to play a salient role in diminishing physical
activity participation, so the goal was to have students realize some of these barriers other students
had faced, and providing students with ways to cope with those barriers. Students were also
encouraged to share some of the barriers that they face on the discussion board, and/or coping
strategies that they had used.
4
The fourth week focused around behavioural modification techniques, specifically targeting
students’ intentions and behaviours. Considering the saliency of academics and time management
as barriers to first-year students’ physical activity, the focus was on action planning and goal setting.
Specific examples of how to action plan, and how to effectively set attainable goals were provided,
in addition to brief descriptions around the benefits to using these behavioural strategies.
5
Following a month of information delivery, week five shifted to physical activity maintenance, and
the importance of sustaining a physically active lifestyle. Students were provided with scenarios of
what a typical student would encounter during busy periods within a semester. Given the context,
students were encouraged to adapt to these disruptions, and to continue with their physical activity
routines following periods of potential inactivity.
6
Similar to the week five, the final week of the intervention encouraged students to sustain their
physical activity while at university. This week was a recap of the previous weeks reinforced the
importance of physical activity, and reiterated the self-regulatory tools that can help students get
back on track when they encountered difficulties. Students were reminded that the website would
be available to them for the remainder of the year, and were encouraged to utilize it when necessary.
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Table 2
Summary of the 3-Phase Pilot Study.
Intervention Piloting Phases
Study Phase
Phase 1
Usability/Acceptability
Phase 2
Efficacy Trial
Phase 3
Focus Groups
Format
Sample
30 minute
independent
review of
website
10 minute
navigational task
N = 15 university
students &
N= 7 physical
activity experts
 Students and experts had high
acceptability ratings across the
web-based format, physical activity
advice, intervention content, and
overall usefulness
 Students had little difficulty with
navigational tasks, and perceived
that the webpage was easy to
navigate
 Minor changes to the website were
made based on participant
suggestions
Baseline and
Post-Intervention
questionnaire
N = 91 at baseline
&
N= 65 at followup
 Non-significant attenuations in
physical activity
 Significant attenuations in some
physical activity cognitions
 No significant difference in
recovery self-efficacy
45-55 minute
meetings
N= 11
 Approve the concept of a physical
activity intervention
 Understand importance of physical
activity
 Ambivalent towards intervention
improvements, acknowledging
difficulties with student
engagement
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Table 3
Descriptive Statistics of Sample Demographic by Study Condition.
Variable
Study Conditions
Full Sample Intervention Comparison
(N = 65)
(n = 38)
(n = 27)
M
M
M
Age
Users
(n = 18)
M
Non-Users
(n = 16)
M
18.51 (0.92) 18.47 (0.92) 18.56 (0.93) 18.22 (1.00) 18.38 (0.88)
n
n
n
n
N
Male
21
11
10
6
6
Female
44
27
17
12
10
1
48
30
18
16
12
2
12
6
6
1
3
3
3
1
2
0
1
4
2
1
1
1
0
Gender
Year of Study
Note: Users = participants assigned to the intervention condition that logged in ≥ 2 times;
Non-Users = participants assigned to the comparison condition that logged in < 1 time.
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Table 4
Descriptive Statistics of Physical Activity Behaviours and Cognitions by Study Condition.
Study Conditions
Variables
Full Sample
(N = 65)
Intervention
(n = 38)
Comparison
(n = 27)
Users
(n = 18)
Non-Users
(n = 16)
Attitude
595.00
(424.41)
5.50 (0.93)
594.47
(443.49)
5.42 (1.01)
595.74
(404.34)
5.60 (0.89)
458.33
(355.21)
5.52 (0.84)
546.56
(396.09)
5.52 (1.01)
Subjective Norm
5.32 (1.52)
5.32 (1.59)
5.31 (1.52)
5.17 (1.61)
5.26 (1.87)
PBC
5.46 (0.92)
5.33 (1.00)
5.65 (0.75)
5.31 (0.87)
5.61 (0.71)
Intentions
6.01 (0.92)
5.98 (0.92)
6.18 (0.92)
5.98 (0.66)
6.31 (0.71)
Attitude
366.96
(341.35)
4.39 (0.86)
393.47
(352.18)
4.49 (0.90)
329.63
(328.37)
4.24 (0.80)
474.44
(355.27)
4.69 (0.64)
424.06
(410.50)
4.04 (0.78)
Subjective Norm
5.36 (1.69)
5.65 (1.70)
5.00 (1.61)
5.39 (1.64)
5.00 (2.00)
PBC
4.90 (1.10)
4.98 (1.25)
4.79 (0.85)
5.18 (0.71)
4.43 (0.83)
Intentions
5.79 (1.28)
6.03 (1.21)
5.45 (0.92)
6.11 (0.73)
5.29 (1.62)
Barriers SE
5.49 (2.52)
5.61 (2.65)
5.32 (2.38)
5.88 (2.42)
4.82 (2.63)
Baseline
MVPA
Follow-up
MVPA
Note: Att = attitudes; SN = subjective norms; PBC = perceived behavioural control; Int =
intentions; SE = self-efficacy. Continuous data variables: age, MVPA, Att, SN, PBC, Int,
recovery SE, represented by M(SD); Categorical data variables: gender, year of study.
Users = participants assigned to the intervention condition that logged in ≥ 2 times; NonUsers = participants assigned to the comparison condition that logged in < 1 time.
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Ph.D. Dissertation – M. Kwan
Figure 1
Example Screenshot of Active Transition.
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Figure 2
Flow Chart of Participants from Recruitment to the End of the 6-Week Efficacy Trial.
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Ph.D. Dissertation – M. Kwan
Figure 3
Example of Weekly Topic Brochure.
P h y s ic a l A c ti v ity a n d Its H e a l th B e n e fits
IM M E D I A T E H E A LT H B E N E F I T S

H e lp s y o u c o n t r o l y o u r s t r e s s

H e lp s w i th s y m p t o m s o f A n x ie t y a n d D e p r e s s io n

I n c r e a s e s y o u r m e t a b o l ic r a te s — h e lp in g w it h w e ig h t m a n a g e m e n t
P R E V E N T I V E M E D I C I N E — “ E x er c i s e a s M e d i c i n e ”

P h y s ic a l a c t iv it y h a s m a n y im p lic a t i o n s fo r f u t u r e h e a l th :
- P re v e n ts so m e f o r m s o f c a n c e r
- C o n t rols h y p e rte n s io n , p re v e n tin g c a rd io v a sc u la r d ise a s e ’ s
like h e a rt a tt a c k s a n d s tro k e s
- P re v e n ts a n d h e lp s c o n tro l D ia b e te s
- P re v e n ts o r d e la y s th e o n s e t o f O s te o p o ro sis
- S tre n g t h e n s y o u r I m m u n e S y st e m
St ud e nt H e a lth :
P h y s i c a l:
P h y s ic a l a c ti v i ty b u f fe r s a g a in s t s tr e s s , f lu s a n d c o ld s
A c ti v e s tu d e n ts h a v e fe w e r d o c to r v is it s f o r i lln e s s e s
P s y c h o l o g ic a l :
A c ti v e s tu d e n ts e x h ib it le s s s o m a tic s y m p t o m s
( e .g . , g e n e r a l f e e l in g o f w e l l- b e in g , h e a d a c h e s , f a ti g u e , e tc .)
A c ti v e s tu d e n ts a ls o a r e le s s a n x i o u s
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Ph.D. Dissertation – M. Kwan
Figure 4
Average usability score among target population (N= 15).
7
6.5
6
Mean
score 5.5
5
4.5
4
Web Format
Advice
Target
Note: Scores are on a 7-point Likert scale.
184
Useful
Ph.D. Dissertation – M. Kwan
Figure 5
Usage statistics among participants assigned to intervention and comparison conditions
(N = 65).
Note: Intervention usage represents the number of times participants logged into the
intervention website.
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Ph.D. Dissertation – M. Kwan
Figure 6
Comparisons of Physical Activity among Intervention and Comparison Conditions (N =
65), and between intervention users and comparison non-users (N = 34).
Weekly
MVPA
Note. MVPA = Moderate and Vigorous Physical Activity.
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Ph.D. Dissertation – M. Kwan
Figure 7
Baseline and follow-up attitude scores comparing participants in the intervention and
comparison conditions (N = 65), and between intervention users and comparison nonusers (N = 34).
7
6
5
4
Baseline
3
Follow-up
2
1
0
Intervention
Comparison
Intervention User Comparison NonUser
Note: Scores are on a 7-point Likert scale.
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Figure 8
Baseline and follow-up subjective norms scores comparing participants in the
intervention and comparison conditions (N=65), and between intervention users and
comparison non-users (N = 34).
7
6
5
4
Baseline
3
Follow-up
2
1
0
Intervention
Comparison
Intervention User
Note: Scores are on a 7-point Likert scale.
188
Comparison
Non-User
Ph.D. Dissertation – M. Kwan
Figure 9
Baseline and follow-up perceived behavioural control scores comparing participants in
the intervention and comparison conditions (N=65), and between intervention users and
comparison non-users (N = 34).
Note: Scores are on a 7-point Likert scale.
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Ph.D. Dissertation – M. Kwan
Figure 10
Baseline and follow-up intentions scores comparing participants in the intervention and
comparison conditions (N=65), and between intervention users and comparison nonusers (N = 34).
Note: Scores are on a 7-point Likert scale.
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Ph.D. Dissertation – M. Kwan
Figure 11
Comparing recovery self-efficacy scores at follow-up between intervention and
comparison conditions (N=65), and between intervention users and comparison nonusers (N = 34).
7
6
5
4
Intervention
3
Comparison
2
1
0
Intervention vs Comparison
Intervention users vs Comparison
non-users
Note: Scores are on a 7-point Likert scale.
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Ph.D. Dissertation – M. Kwan
CHAPTER 6
General Discussion
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Ph.D. Dissertation – M. Kwan
6.0 Program of Study Contributions
There is little dispute that there is many health benefits associated with regular
participation in physical activity, and failure to meet recommended levels of physical
activity is a major public health concern.
Across the lifespan, physical activity
participation appears to be at its highest during the adolescent period before steadily
decreasing (Dishman, Washburn, & Heath, 2004). However, this decline does not occur
linearly, and there is evidence to suggest that these declines are most pronounced during
the transition into early adulthood (Caspersen, Pereira, & Curran, 2000; Gordon Larsen,
Nelson, & Popkin, 2004; Malina, 2001a, b). Recently, there has been a greater impetus
placed on understanding the factors relating to the declines in physical activity
behaviours during this transitional period (Sparling, 2007). The overall objective of the
current program of research had two key interests in mind. The first was to develop a
program of research that produced novel research findings, addressing some deficits in
our current knowledge around declining physical activity behaviours during the transition
from adolescence to early adulthood. Concurrently, the goal was to design a program of
research that would be challenging from a pedagogical standpoint through conducting a
series of studies that utilized a diverse range of research methodologies.
6.1 Contributions to Advancing Research
The research examining physical activity decline during the transition from high
school to college remains in its infancy. As introduced in chapter 1, a critical stance
might be taken in questioning whether a focus on physical activity among individuals
transitioning to college or university is warranted – in the context of other health-risk
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Ph.D. Dissertation – M. Kwan
behaviours that tends to overshadow physical activity, and given educational attainment
is itself consistently associated with greater physical activity. The findings from the
current research programme have addressed these issues across three studies, providing
contributions towards intervention efforts targeting the first-year university student
population: 1) Physical activity decline is evident among all young adults during the
transition into early adulthood regardless of educational trajectory – however, the decline
is most pronounced for males entering college/university; and the decline in physical
activity is particularly concerning as other health behaviours such as smoking and binge
drinking begin to stabilize or decrease in early adulthood. 2) University students are
concerned about their declining physical activity levels, and are receptive to physical
activity interventions; however, such concerns are inflected with ambivalence that may
pose a challenge for future interventionists. 3) A website-delivered physical activity
intervention is feasible in this population; but more creative steps are required to engage
students in these types of intervention.
Overall, these findings demonstrate that
college/university is an important setting for focused intervention work in parallel with
broader population-level and workplace-based initiatives for helping attenuate the
significant declines in physical activity during the transition into early adulthood.
6.1.1 Longitudinal examination of physical activity and other health behaviours
The purpose of study 1 was to examine physical activity behaviours
longitudinally as Canadians transitioned from adolescence into early adulthood,
discerning patterns of physical activity based on gender and educational trajectory.
Patterns of smoking and binge drinking behaviours were also examined to provide a basis
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Ph.D. Dissertation – M. Kwan
of comparison. Results confirmed that Canadians are susceptible to physical activity
declines during the transition from adolescence to early adulthood; however, males that
transitioned to college/university demonstrated the most precipitous declines. This was a
key finding, providing justification for research with first-year college/university
students, and highlights the necessity for campus-based initiative targeting physical
activity declines.
With an increasing number of young people attending
college/university, this setting has been recognized as an important context for which an
intervention can be developed (Sparling, 2003). Situated within institutions conducive to
establishing community norms and policies, there are unique opportunities for students to
be educated intellectually, experientially, and systematically to help shape healthy habits
– including physical activity (Brener & Gowda, 2001; Sparling, 2003).
Smoking and binge drinking are additional health behaviours considered to be
modifiable causes of mortality, and problematic among the young adult population
(Poortinga, 2007; Schuit, van Loon, Tujhuis, & Ocke, 2002). The results were somewhat
surprising in that patterns of these health-risk behaviours did not differ on the basis of
gender or educational trajectories.
However, because binge drinking and cigarette
smoking were at its highest level during the transition out of high school, including for
the collegiate population, there is obviously a continued need for coordinated campus and
employment-wide strategies to focus on these multiple health behaviours. As mentioned
earlier, concerns about smoking and drinking among the college and university students
have typically overshadowed the need to emphasize behaviours like physical activity
(Sparling, 2007).
Current findings, however, suggest that this emphasis is being
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Ph.D. Dissertation – M. Kwan
misplaced. While physical activity continues to decline into early adulthood, smoking
and binge drinking behaviours tend to stabilize or decline in the years following
college/university.
These findings clearly indicate that there is a greater need for
administrators, staff and student bodies need to address declining physical activity as a
major health concern. Currently, campus health services (e.g., University of Toronto,
Mount Royal University) utilize surveillance tools such as the Canadians Health Survey
or the National College Health Assessment to inform their health promotion strategies;
however, the assessment of physical activity within these measurement tools is weak.
More efforts are required to develop the capacity for physical activity surveillance among
the collegiate population in order to provide health services with accurate information to
intervene accordingly.
Conducting this study required the development of statistical skills in working
with large datasets and executing multi-level modeling statistical techniques. These skills
will provide the opportunity for future examination of the NPHS dataset to address a
range of questions left unanswered by the current analyses. First, what happens in the
transition from early adulthood to later in adulthood? Following an early adult cohort
over time will allow examination of whether differences in these health behaviours on the
basis of educational trajectory become more pronounced later in adulthood. Second,
longitudinal cluster analyses could be conducted to identify the characteristics among the
population that maintained their physical activity behaviours during their transition from
adolescence and early adulthood. These characteristics could be compared to clusters of
individuals that demonstrate change in behavioural patterns, potentially creating a profile
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Ph.D. Dissertation – M. Kwan
among those most susceptible to physical activity declines. Lastly, given that each of the
health-risk behaviours were examined independently, future research could also examine
how these health behaviours interact among one another.
6.1.2 Formative Research
The purpose of the second study was to obtain a better understanding of the
experiences students had during their transition into university. This study represents the
first qualitative study exploring students’ perceptions of the physical activity decline,
while exploring their interests and preferences towards a prospective physical activity
intervention. Efforts to intervene with this population have possibly been hampered by
not asking whether physical activity decline is of concern to students, what barriers had
the greatest impact on their physical activity, and what their preferences would be for a
physical activity intervention. Therefore, the second study addresses these deficits in our
understanding of the first-year university student population.
Consistent with previous research, students indicated that they entered university
with a positive attitude towards physical activity and had strong intentions to be active
(e.g., Kwan, Bray, & Martin Ginis, 2009). However, as their first semester proceeded,
students shifted their priorities, and academic achievement became a primary focus.
Students recognized the benefits of being physically active but were mostly ambivalent
about taking steps to be more active. Nevertheless, students did express an interest
towards the prospect of a physical activity intervention.
The challenge for
interventionists, however, will be addressing this ambivalence and engaging students in
such interventions. Further research is required to examine how the immediate benefits
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Ph.D. Dissertation – M. Kwan
of physical activity interacts with the priorities of students – the impact that academic and
social benefits of being physically active may promote. The salience of these benefits
might be critical to overcoming their ambivalence and could be better integrated into
campus-based initiatives aimed at physical activity promotion.
To inform intervention development, study 2 also identified salient physical
activity barriers and the preferences for physical activity interventions. In general, the
physical activity barriers that students identified were consistent with the findings of
previous research (e.g., Gyurcsik et al., 2004; Kwan et al., 2009). The common barriers
that students cited were related to time and school, motivation, and intimidation. In
trying to understand what methods/messengers would be appropriate for a prospective
physical activity intervention, participants were less able to clearly describe what would
be helpful.
Without having particular knowledge or expertise in intervention
development, focus group participants had a difficult time with providing specific details
regarding the intervention content. However, confirming the findings of Kwan and
colleagues (2010), students did acknowledge that the Internet would be the preferred
method for physical activity-related information to be delivered to the students.
Furthermore, without being prompted, students suggested that an intervention should
either utilize Facebook or Blackboard. These were coincidentally the same platforms that
were being considered early in the development of this research programme. Overall, it
provided confirmation that a website-delivered intervention using either Facebook or
Blackboard would be appropriate.
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Ph.D. Dissertation – M. Kwan
Conducting the second study provided the opportunity to develop the skills to
conduct focus groups and analyze qualitative data.
In developing these skills,
information was gathered that was critical to the development of the final intervention
study. This experience will be invaluable in the future by ensuring that interventions I
develop are grounded in the interests and preferences of the target population. In the
context of first-year college/university students, future qualitative research would be
useful in exploring further the issue of ambivalence towards physical activity while
adapting to university lifestyle. In particular, more work is required in eliciting feedback
regarding novel approaches for engaging students in physical activity initiatives and
interventions in ways that resonate with student life. Conducting qualitative research with
students who maintain or increase their physical activity during this transitional period
would also be informative.
6.1.3 Making the active transition
The purpose of study 3 was to examine the feasibility of a website-delivered
physical activity intervention. Using the Medical Research Council (MRC) framework
for development and evaluation of complex interventions (see MRC, 2008), this final
study was a 3-phased pilot study examining ‘Active Transition’. The results of the pretesting were positive, with the website and its content being both acceptable and usable to
the target audience, as well as for the physical activity experts. Subsequently, an efficacy
trial of Active Transition was conducted to examine the effect on students’ physical
activity cognitions and behaviours. While the intervention was unable to attenuate the
declines in students’ physical activity at the statistically significant level, an extra 60
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Ph.D. Dissertation – M. Kwan
minutes per week of physical activity among the intervention condition is potentially
meaningful from a public health perspective if maintained.
The results of the efficacy trial also found Active Transition to successfully
attenuate significant declines in students’ physical activity cognitions.
Specifically,
participants in the comparison conditions exhibited greater declines in their intentions
and perceived behavioural control compared to participants in the intervention
conditions.
This was particularly significant as this was the first investigation that
examined the intervention effects on students’ physical activity cognitions. Although the
stability among the specific TPB variables during the transition into university have not
previously been examined, recent research suggests that changes in physical activity
motivations do occur in the year following high school graduation (Martin, 2010).
Therefore, it is promising that Active Transition helped students maintain physical
activity cognitions – important determinants towards their physical activity behaviour.
However, because the attenuations in students’ physical activity cognitions were not
consistently associated with behaviour change, results do suggest that there may be other
influences on behaviour that the intervention did not address.
Overall, modest compliance in terms of intervention usage may be the primary
reason for modest impact on physical activity behaviour. In line with findings from study
2, the results again demonstrate the need to look at innovative ways to get students
engaged. Future intervention efforts may want to try and utilize other Internet-based
tools, such as social media and social networking. There is empirical evidence to suggest
that intervention effects are markedly improved if it a) is theory-based and b) is
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integrated with personalized contact (vandenBurg et al., 2007; Webb et al., 2010).
Technology has profoundly changed the way information is being delivered, and how
people connect with one another. Therefore, it appears imperative that attempts are made
to integrate these emerging technologies with intervention efforts aimed at behaviour
change. Further research is necessary to determine what appeals to students, and how
these technological tools can be maximized for helping facilitate greater physical activity
participation. For one, Active Transition may want to be delivered via Facebook. This
was suggested by first-year students in study 2, thus, it appears to be an acceptable
intervention delivery vehicle. However, in an effort to augment Active Transition, a
Facebook intervention could also integrate the use of short messaging service (SMS) or
text messaging, acting as a reminder or prompt to students.
Designing and conducting an intervention was the highlight of this research
programme. From a personal perspective, it was gratifying to utilize findings from my
previous research work (i.e., Master’s thesis), and the results from my first two studies to
develop a theoretically-informed website-delivered physical activity intervention. This
experience also reinforced the need for carefully developing and piloting intervention
components as outlined by the Medical Research Council (2008).
This pilot study
confirmed that the internet may be a useful method for delivering physical activity
interventions. Housing such an intervention within an institutional portal such as
Blackboard makes intuitive sense as it allows for national (campus-wide) dissemination.
However, future research and practice will require greater resources to evaluate the
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Ph.D. Dissertation – M. Kwan
addition of more current and popular forms of social media and networking tools for
engaging students.
6.2 Final Conclusion
Overall, the research and knowledge generated within this dissertation satisfied its
overall objective. By utilizing a diverse range of research methodologies, I contributed
novel research in addressing some of the deficits in the current knowledge around
physical activity decline during the transition from adolescence to early adulthood. The
transition from high school into university is a truly unique context that captured my
research interest as an undergraduate student. Progress in understanding physical activity
during this transition has certainly been made since that time. From early behavioural
surveillance studies, studies investigating the acute consequences associated with
physical activity, to theory-based research understanding the determinants of physical
activity behaviours, a number of pieces to the puzzle began to emerge. The current
research programme has addressed many of the gaps that were remaining.
This
dissertation has provided justification for why it is pivotal that research continues work
with this population and has provided the foundations for implementing a populationlevel initiative to help students attenuate the declines in physical activity as they embark
on their transition into early adulthood.
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References
Brener ND, Gowda VR. U.S. college students’ reports of receiving health information on
college campuses. Journal of American College Health 2001;49:223–228.
Casperson, C. J., Pereira, M. A., & Curran, K. M. (2000). Changes in physical activity
patterns in the United States, by sex and cross-sectional age. Medicine and
Science in Sports and Exercise, 32, 1601-1609.
Dishman, R.K., Washburn, R.A., & Heath, G.W. (2004). Physical Activity Epidemiology.
Champaign, IL: Human Kinetics.
Gordon-Larsen, P., Nelson, M.C., & Popkin, B.M. (2004). Longitudinal physical activity
and sedentary behavior trends: Adolescence to adulthood. American Journal of
Preventive Medicine, 27, 277-283.
Gyurcsik, N.C., Bray, S.R., Brittain, D. (2004). Coping with barriers to vigorous physical
activity during transition to university. Family Community Health ,27, 130-142.
Kwan, M.Y.W., Arbour, K.P., Lowe, D., Taman, S., & Faulkner, G. (2010). Seeing may
not be believing: Student reception, sources, and believability of health-related
information. Journal of American College Health, 58, 555-562.
Kwan, M.Y.W., Bray, S.R., & Martin Ginis, K.A. (2009). Predicting physical activity
during transition to first-year university: An application of the Theory of Planned
Behavior. Journal of American College Health, 58, 45-52.
Malina, R.M. (2001a). Adherence to physical activity from childhood to adulthood: A
perspective from tracking studies. Quest, 53, 346-355.
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Malina, R.M. (2001b). Physical activity and fitness: Pathways from childhood to
adulthood. American Journal of Human Biology, 13, 162-172.
Martin, A.J. (2010). Physical activity motivation in the year following high school:
Assessing stability and appropriate analytical approaches. Psychology of Sport
and Exercise, 11, 107-113.
Medical Research Council. (2008). Developing and evaluating complex interventions:
new guidance. London: Medical Research Council.
Poortinga, W. (2007). The prevalence and clustering of four major lifestyle risk factors in
an English adult population. Preventive Medicine, 44, 124-128.
Schuit, A., van Loon, J., Tijhuis, A.J.M., & Ocké, M. (2002). Clustering of lifestyle risk
factors in a general adult population. Preventive Medicine, 35, 219–224.
Sparling, P.B. (2007). Obesity on campus. Preventing Chronic Disease, 4, 1-4.
Sparling, P.B. (2003). College physical education: an unrecognized agent of change in
combating inactivity-related diseases. Perspectives in Biology and Medicine, 46,
579-587.
Van den Berg, M.H., Schoones, J.W., & Vliet Vlieland, T.P.M. (2007). Internet-based
physical activity interventions: A systematic review of the literature. Journal of
Medical Internet Research, 9, e26.
Webb, T.L., Joseph, J., Yardley, L., & Michie, S. (2010). Using the internet to promote
health behavior change: A systematic review and meta-analysis of the impact of
theoretical basis, use of the behavior change techniques, and mode of delivery on
efficacy. Journal of Medical Internet Research, 17, e4.
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Appendix A
STUDY 1 Materials
Appendix A.1
NPHS Measure of Physical Activity
Appendix A.2
NPHS Measures of Drinking Behaviour
Appendix A.3
NPHS Measures of Smoking Behaviour
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Appendix A.1 – Summary of Questions and Categories Included in the Physical Activities Module
Description of Question
Categories/Coding
Activity in last 3 months – walking, swimming, ice hockey, etc
Yes
No. of times participated – walking, swimming, ice hockey, etc
1-600
Time spent – walking, swimming, ice hockey, etc
1 to 15 min
No
16 to 30 min
31 to 60 min
More Than
One Hour
Usually Lift
or Carry
Light Loads
Do Heavy
Work or
Carry Very
Heavy Loads
Level of physical activity for usual day
Usually Sit and
Don’t Walk Much
Stand or Walk
Quite A Lot
Daily energy expenditure
0
0.1-35.2
Participation in daily physical activity lasting >15 min.
Daily
Not Daily
Monthly freq. of physical activity lasting >15 min.
0
1-251
Freq. of all physical activity lasting >15 min.
Regular
Occasional
Participant in leisure physical activity
Participant
NonParticipant
Physical activity index
Active
Moderate
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Infrequent
Inactive
Ph.D. Dissertation – M. Kwan
Appendix A.2 – Summary of Questions and Categories Included in the Alcohol Consumption Module
Description of Question
Categories/Coding
Drank alcohol in past 12 months
Yes
No
Frequency of drinking alcohol
<1/mth
1/mth
2-3/mth
1/wk
2-3/wk
4-6/wk
Frequency of having 5 or more drinks
Never
<1/mth
1/mth
2-3/mth
1/wk
>1/wk
Drank alcohol in past week
Yes
No
Ever had a drink
Yes
No
Regularly drank more than 12 drinks
a week
Yes
No
Reason reduced drinking – dieting,
getting older, pregnancy, etc
Yes
No
Average daily alcohol consumption
0-14
NonDrinker
Now
Never
Drinker
Type of drinker
Regular Drinker
Weekly alcohol consumption
0-99
Occasional
Drinker
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Everyday
Ph.D. Dissertation – M. Kwan
Appendix A.3 – Summary of Questions and Categories Included in the Smoking Module
Description of
Question
Categories/Coding
Smoked at Last
Interview
Family/Friends
Smoke
Everyone Around
Me Smokes
Started Again After
Trying To Quit
Cost
To Control
Weight
Other
Did Not Cut Down
Trying To Quit
Affected Physical
Health
Pregnancy
Smoking
Restrictions
Haven’t Increased
Curiosity
Stress
Cost
Social/Family
Pressures
Athletic
Activities
Doctor’s Advice
Effect of
Second-Hand
Smoke On
Others
Other
Family/Friends
Smoke
Everyone Around
Me Smokes
To Be “Cool”
Curiosity
Increased After
Trying To
Quit/Reduce
To Control Weight
Other
Current smoking
status
Daily
Occasionally
Not at all
Tried quitting
Yes
No
Reason for starting
smoking
Reason for smoking
less
Reason for smoking
more
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To Be “Cool”
Stress
Ph.D. Dissertation – M. Kwan
smoking
Number of times
tried to quit smoking
1-25
Considering quitting
smoking in the next
30 days
Yes
No
Yes
No
Table 2: Continued
Considering quitting
smoking in the next
6 months
Age started smoking
daily
5-81
Number of cigarettes
smoked each day
1-99
Number of years that
respondent smoked
0-77
Ever smoked daily
Yes
Age stopped
smoking daily –
former daily smoker
10-90
No
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Ph.D. Dissertation – M. Kwan
Never Smoked
Didn’t Smoke at
Last Interview
Affected Physical
Health
Cost
Social/Family
Pressures
Pregnancy
Smoking
Restrictions
Doctor’s Advice
Effect of
Second-Hand
Smoke on
Others
Other
Daily Smoker
Occasional Smoker
(Former Daily
Smoker)
Always an
Occasional
Smoker
Former Daily
Smoker
Former
Occasional
Smoker
Reason for quitting
smoking
Type of smoker
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Athletic
Activities
Never
Smoked
Ph.D. Dissertation – M. Kwan
Appendix B
STUDY 2 Materials
Appendix B.1
Focus Group Schedule
Appendix B.2
Example Recruitment Flyer
Appendix B.3
Demographic Questionnaire
Appendix B.4
Letter of Information and Consent
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Ph.D. Dissertation – M. Kwan
Appendix B.1 – Focus Group Schedule
Focus group interview schedule
Introduction
I am a Ph.D. student in exercise psychology, and I am interested in understanding how
you adjusted to your first year of university. I would like to ask you a series of questions
specifically to do with your physical activity involvement while you were in high school,
and more recently during your first year of studies. These questions are intended to
prompt your experiences as a first-year student; to identify some of the barriers that you
encountered, which may have contributed to your declines in physical activity levels;
ways that you or your peers have coped with some of those barriers; and how an
intervention may be able to help you and other first-year students sustain your physical
activity levels better. The information you will provide will be kept strictly confidential.
If you agree to proceeding with the interview, please sign the bottom of this letter
[Provide letter of consent].
Background Information
You were invited to participate in this interview because you indicated that your physical
activity levels declined during your transition into your first year at university.

First, I just need you to complete this demographic questionnaire; used for
reporting purposes.

Now I’ll want to throw out a general question to you all: How has the university
experience been for you all of you? Are you enjoying it?
o Prompt—has it been different than you had anticipated?

So how would you say physical activity fits into your first-year university
experience? Is it something you think about?
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Ph.D. Dissertation – M. Kwan
o Prompt—is it in the forefront of your day to day thoughts?

Has your decline in your physical activity levels been a concern at all?
o Would you have wanted to, or want to for the rest of your university
experience be more active than you currently are?
Barriers to Physical Activity
Now, I want to get to crux of it and have you think of some of the reasons why there was
a decrease in your physical activity levels. So, let’s start to think about Barriers:

What were some of these barriers or things that hindered you from being more
active during first-year university? Let’s compile a list of these barriers…
o Examples for prompts: [School, People, Motivation, Moving]
o Are there any other ones that you feel we may have missed?
I want to take a moment just to group these barriers now…[On white board]. I want to
categorize these based on a theoretical model that has 4 groups; personal ones
(intrapersonal barriers), social ones (interpersonal barriers), environmental ones
(environmental barriers), and community ones (community barriers). Lets fill in this
list…[On the white board, arrange the barriers that were identified into one of these 4
groups]. Can you tell me where you would think each of these barriers might fit in…

Does this look about right?

Do you think we missed any key barriers that you or maybe others around you
have faced? Would any others fit into one of these 4 groups?

Which of these are the most important ones?
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Ph.D. Dissertation – M. Kwan
Facilitators to Physical Activity
Now that we have established some of the barriers possibly preventing your physical
activity participation, let’s talk about some of the things that could have helped you
overcome some of these barriers, to help you become more active.

Taking a moment to think about the barriers you encountered since you entered
university [refer to blackboard], is there anything that you did or could have done
to help overcome some of your barriers.
o What methods could have helped overcome some of your personal
(intrapersonal) barriers?
o What methods could have helped overcome some of your social
(interpersonal) barriers?
o Are there any ways the institution/the university, or community could
have helped you overcome some of the community barriers?
o Can you suggest any ways for us to target some of the environmental
barriers?
Opportunity for Intervention
Thanks for sharing with me those barriers and facilitators. That was really helpful…
For this last section, I want you to think about ways or things that could have perhaps
helped you be more active during your first year…

First of all, do you think there would be any interest in having a program
[intervention] to help first-year students in general be active?
o Maybe something that answer questions you may have about
sports/exercise/teams etc?
o If all this information would be centrally accessible, would it help?
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Ph.D. Dissertation – M. Kwan

Could you share some ideas with me about how you would envision a program or
intervention that may be of use?
o Prompt: how would you want to get this information?
o Prompt: what kind of information would you want?
o What kind of intervention would you be entered in?

Since the internet is a popular tool these days [perhaps if they have already
mentioned this— since you have mentioned the Internet], where virtually all
students will have access to it, what do you think about the Internet as a tool to
deliver an intervention?

What I had in mind was to use the information you have provided me, talking
about the barriers you faced, and ways that you overcome them—and adapting it
into information that may be helpful… Do you think others would find this
useful?
o If we set up a website dedicated to first-year students like facebook, where
you can interact with other people in your residence, to try and set up
teams or groups for various activities… would you use it?

Since you have indicated that this could be helpful [or not helpful], what do you
think we can do to try and entice other students like yourself, to engage in this
[some] type of program or intervention?
That concludes our interview. I want to thank you for sharing so much information about
yourself and your experience during the transition to university with me. I want to assure
you once more that this information will be treated with strict confidentiality. Again, if
you wish to see the results from this study, please contact me. Thank you for your time!
215
216
Matt Kwan
(416)978-7571
[email protected]
Matt Kwan
(416)978-7571
[email protected]
Matt Kwan
(416)978-7571
[email protected]
Matt Kwan
(416)978-7571
[email protected]
Matt Kwan
(416)978-7571
[email protected]
Matt Kwan
(416)978-7571
[email protected]
Matt Kwan
(416)978-7571
[email protected]
Matt Kwan
(416)978-7571
[email protected]
Matt Kwan
(416)978-7571
[email protected]
Matt Kwan
(416)978-7571
[email protected]
Ph.D. Dissertation – M. Kwan
Appendix B.2 – Example of Recruitment Flyer
FIRST-YEAR STUDENTS:
Have your physical activity levels decreased from
high school?
Participants needed for 60-90min focus groups. Participants
will receive food, beverages, & $10 compensation. Please
contact: Matt Kwan, (416)978-7571, [email protected]
Ph.D. Dissertation – M. Kwan
Appendix B.3 – Demographic Questionnaire
Demographic Questionnaire, Focus Groups 2009
1. What is your year of study?
2. Sex:
 Male
3. Age:
years
1
st
 Other
 Female
4. Where do you live (check one):
 UofT Residence
 On your own (off-campus)
 With family
For the next question:
Recall your average weekly participation during your last 6 months of high school and during university.
Write the average number of times you did this for at least 30 minutes in a typical week. Note: 30 minutes
can be accrued through bouts of 10 minutes or more (E.g., Doing 3 or more bouts of 10 minutes of physical
activity)
A) STRENUOUS EXERCISE
(HEART BEATS RAPIDLY)
During High School
During University
Times per week
Times per week
During High School
During University
Times per week
Times per week
(e.g., running, jogging, hockey, football, soccer,
squash, basketball, cross country skiing, judo,
roller blading, vigorous cycling)
B) MODERATE EXERCISE
(NOT EXHAUSTING)
(e.g., fast walking , baseball, tennis, easy bicycling
volleyball, badminton, easy swimming ,
alpine skiing, popular and folk dancing)
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Ph.D. Dissertation – M. Kwan
Appendix B.4 – Letter of Information and Consent
U niv ersity of T oronto
D epartment of Exercis e S ciences
Letter of In formation an d Con sent
“Barriers to physical activity during the transition to university”
D ear Study Participant:
O verview: Thank you for taking part in the s tudy on “barriers to physical activity during the
transition to university”. A s a part of my P hD work (funded by the S ocial Sciences and H umanities
Research Council), you as a first-year student, are being asked to take part in a focus group
interview . A s a group, w e will be discussing several issues pertaining to barriers and facilitators to
physical activity during your first year of univers ity, as well; w e are looking to gather your opinions
in regards to future intervention efforts. It is up to you to decide w hether or not to take part, and
you will be w elcome to terminate your participation at any time during the interview w ithout any
cons equence.
Pr ocedure: This interview w ill be moderated by m ys elf, and will take approximately 90 m inutes to
complete. The intervie w w ill be tape-recorded and later trans cribed for data analys is. The
inform ation from this interview is entirely confidential and will be reported in future reports in
general term s without reference to any particular pers on. If you w ish to obtain a copy of these
res ults, you may contact m e.
Risk/Benefits : You w ill not be asked questions that are intrus ive or s ens itive; how ever, for s om e
people the discussion of health and physical activity is sues m ay rais e concerns about their ow n
health or activity level. We w ill ensure that you are referred to resources that can provide
appropriate guidance. Y ou w ill be reimburs ed $10 for your tim e. Y our participation w ill help in
the development of an intervention aimed at helping first-ye ar s tudents s us tain their physical
activity levels. Anonym ity and confidentiality w ill be preserved. Y ou w ill not be identified in any
docum ents relating to the research, and the tapes and transcripts from this interview w ill be kept in a
locked office in locked cabinets, only available to mem bers of the research team .
W e w ant to thank you for your interest in participating. If you have any further questions about
your rights as a research participant, please contact Zaid G abriel, Research Ethics Review O fficer,
H ealth S ervices zaid.gabriel@ utoronto.ca or (416)946-5806.
M r. M atthew Kw an, Ph.D. Candidate
D epartment of Exercis e S ciences
U niversity of Toronto
P hone: (416) 978-7571 E -m ail: m atty.kw [email protected]
- --- ---- -- -- -- -- -- -- -- -- -- -- -- --- ---- -- -- -- -- -- -- -- D etac h an d R etur n Sig ned --- ---- ---- ---- ---- -- -- -- --- ---- ---- ---- ---- ------ -- -- --- -
I con sent to p articipate in th is aud io-tap ed focu s group interview for the s tu dy entitled
“Barriers to p hys ical activity d uring th e tran sition to un iversity” as d escribed in th e letter of
information.
P rinted Nam e: ______________________
Signature: ______________________
D ate:
218
Ph.D. Dissertation – M. Kwan
Appendix C
STUDY 3 Materials
Appendix C.1.
Active Transition Printable Intervention Content
Appendix C.2
Pre-Testing Letter of Information and Consent
Appendix C.3
Pre-Testing Acceptability Questionnaire
Appendix C.4
Pre-Testing Usability Questionnaire
Appendix C.5
Efficacy Trial Letter of Information and Consent
Appendix C.6
Efficacy Trial Baseline Questionnaire
Appendix C.7
Efficacy Trial Follow-up Questionnaire
Appendix C.8
Formative Evaluation Focus Group Schedule
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Ph.D. Dissertation – M. Kwan
Appendix C.1 – Active Transition Printable Intervention Content
Physical Activity to Increase Energy
FATIGUE FRO M CLASSES AN D SCHO O LW ORK?

Are you feeling ti red from a l ong day at school? — Go do someth ing active!
Taking the time each day to be acti ve WILL h elp you increase your energy levels.

Physical activity del ivers oxygen an d nutrients into you r body ti ssues, and wil l hel p
w ith your overal l cardiovascul ar system (blood circu lation).
As a result of your heart and lungs working more efficiently , you will have
more en ergy to do things—including studying.
PHYSICAL ACTIVITY and YO UR GRADES

Regular physical activity parti ci pation is associated with better sleep :
- Falling asleep faster
- Getting into de eper slee p
- F eeling more rested in the morning

A better n ight’s rest wil l help you wi th:
- Concentration
- Productiv ity
- Effe ctiveness in School
Bottom Lin e: Physically active students typically obtain better grades at un iversity
than N ON-active students.
A students’ account:
My transition into univ ersity was difficult. I felt lots of pre ssure to do we ll in school,
but the more that I was study ing, the more drained I felt. I used to do sports all the
time, but there w as no way I could do the se activities—I fe lt too tire d, and there was
just not enough time to do it. When I went to the doctors for my check-up, I had
mentioned that I was chronically e xhausted. After doing blood tests and ev ery thing,
his message to me was that I ne eded to dedicate some time each day to ex ercise. I
used to run, so I decided that I w as going to pick it up. Eve n after a week of
running 3 tim es, I felt so much be tte r… This exe rcise stuff really works!
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Ph.D. Dissertation – M. Kwan
Physical Activity Helping Your Social Life
PHYSICAL ACTIVITY CAN ENHANCE YOUR SOCIAL LIFE

Sport and exercise— A great way to meet new people
Make new friends
Meet new people in your residence
Find people with similar interests

Exploring & diversifying your social network can ease your transition into university

Group activities are always a great way to start new relationships!
BEING ACTIVE HELPS YOU MAKE A GOOD IMPRESSION

Being physically active makes a difference to how you are perceived by others
Active people are perceived to be more attractive
Active people are perceived to be more fun & likable
Active people are perceived to be smarter
Being and Looking Your Best:
Albeit superficial, recent statistics indicates that attractive people are more successful. The
impressions you make are important, and physical activity can help get you feeling and looking
your best. Education is certainly getting you ahead, but so could your lifestyle!!
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Ph.D. Dissertation – M. Kwan
Weight Management and Physical Activity
FRESHMAN 15

The “Freshman 15”—gaining 15lbs during the fresh man year at college/university—is a MYTH!!
SORT OF…

Weight gain is typical during transition to university; however, the average freshman gains
closer to 5-7lbs— substantially less than the mythical 15lbs.
WEIGHT MANAGEMENT
Being regularly active is the most important thing!

Don’t get too hung up on Weight— Latest research suggests that being overweight may not
be as problematic:
Active overweight individuals are healthier THAN Inactive healthy weight individuals. Physical
activity h elps you control your weight by
using excess calories (otherwise stored as fat).

Body Mass Ind ex (BMI) is a good g eneral diagnostic
tool to help to gauge ideal/healthy weight.
BMI =

Weight (kilograms)
------------------------------Height 2 (meters squared )
For your BMI, go to: http://www.findmybmi.com
The general criticism with BMI is that it does not account for other factors associated with
healthy weight, including your activity level, and muscle mass.
Interesting Fact:
Recent studies from McMaster University & University of Guelph indicate that it
is NOT the changes in dietary behaviours that causes weight gain during the
transition to university, RATHER, it is the decreases in energy expenditure &
physical activity.
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Ph.D. Dissertation – M. Kwan
Physical Activity and Its Health Benefits
IMMEDIATE HEALTH BENEFITS

Helps you control your stress

Helps with sym ptoms of Anxiety and Depression

Increases your metabolic rates—helping with weight management
PREVENTIVE MEDICINE— “Exercise as Medicine”

Physical activity has many implications for future health:
- Prevents some forms of cancer
- Controls hypertension, preventing cardiovascular disease’s
like heart attacks and strokes
- Prevents and helps control Diabetes
- Prevents or delays the onset of Osteoporosis
- Strengthens your Immune System
Student Health:
Physical:
Physical activity buffers against stress, flus and colds
Active students have fewer doctor visits for illnesses
Psychological: Active students exhibit less somatic symptoms
(e.g., general feeling of well-being, headaches, fatigue, etc.)
Active students also are less anxious
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Ph.D. Dissertation – M. Kwan
Barriers
To physical Activity
Barriers to physical activity appear more prevalent while at university. Although you may foresee some,
others may be unanticipated.
Here is a list of some common barriers— described by students who had previously
transitioned into university
 Social
 Lack of Time from School
- Roommates want to go party
- Heavy workload
- Exercise is not a priority
- Classes offered do not
fit into your schedule
- Procrastination leaving little time
- Stress
- Friends are inactive
- Friends interested in different activities
- Having no encouragement from others
to exercise
- Having a different group of friends at
university
 Motivational
 Health-Relat ed
- Feeling too lazy
- Activities not competitive enough
O R too competitive
- Limited activities offered
- Don’t know what activities are offered
- Being homesick
- Being sick
- Dealing with injury
- Health problems that limit your exercise
(e.g., asthma, allergies)
 Self-Presentational and Enjoyment
- Feeling intimidated by environment
- Body Discomfort
- Pressure to perform (on teams O R
in classes)
- Uncomfortable with trying new activities
Important Questions:
Are you confident that you could cope with these barriers?
What are the necessary steps you would take to help overcome these barriers?
Will these barriers deter you from being physically active?
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Ph.D. Dissertation – M. Kwan
Coping with Barriers
To physical Activity
Finding Time for Physical Activity
Time Manage ment. It m ay be cliché … But it’s about balance …
Schedule physical activity as you would an appo intment or mee ting. Do n't change you r e xe rcise plans for every in te rruption
that com es along. Rem ind your se lf th at physical a ctivity is im por ta nt too!
Be active while running e rrands. Whe n you go to the groce ry store o r sho pping, b e active.
Take the stairs. If you a re roam ing b etwee n flo ors at your re side nce , use th e stairs, n ot the elevators.
Start pick-up game s/ activitie s with your floo rmate s. This is a great way to inte ract with one anothe r. Sh are a fe w laughs, and
be active in a fun wa y. Rathe r than hanging o ut with frie nds in your lounge , go for a wa lk to gr ab a dr ink o r sna ck.
Set goals. Start with simp le goals and then progress to lon ger ran ge go als. Rem emb er to m ake your go als re alistic and
achievable. It's easy to ge t frustrate d an d give up if yo ur goals are too ambitious.
Staying Motivated
Be fle xible! Unde rstand that life ge ts in the way. If yo u'r e to o busy to wor k out o r simp ly d on' t feel up to it—an d the se
tim es will hap pen —take a d ay or two off. Don’t wor ry abo ut it! The im portant thing is to get ba ck on tr ack as soon as yo u
can.
Think varie ty. Varying activitie s will help ke ep you e nga ge d. Alte rnate your activitie s. For e xam ple, you might do a sp ort
one night, swim by yourse lf twice a week, and join p ilate s with a fr ie nd. Wh en the we ather coo per ate s, do ac tivities outsid e
to e njoy fr esh air. It’s all up to you !!! Do n’t b e a fra id to try some thin g n ew!
Have fun. You' re mo re likely to continue being physically active if you'r e having fun. If you' re not enjoying an activity, try
some th ing d iffe ren t. Join a volleyb all or softba ll le agu e, or ma ybe e ve n a ballroom d ancing class.
Reward yourse lf. Whethe r it is school-related o r life ch oices, so metime s you nee d to re flec t on what you' ve just
acco mplished. Whe n you rea ch a longer range goa l, tr eat your self to so mething you desire .
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Ph.D. Dissertation – M. Kwan
Self-Presentational
Find what you are comfortable with: The re are so ma ny ways to be active on cam pus… find so mething you want to do
that will make yo u fee l as com for ta ble a s po ssible .
Physical A ctivity and Competition: There is a m yth that everything a ssociated with spo rts and e xer cise are supe r
com petitive. It may b e tru e tha t there ar e com petitive elem ents within spo rt ac tivities, BUT the re are also va rying levels o f
com petition s, and var io us e xe rcise classes catering to var io us levels o f exper ie nce.
Don’t be afraid to ask, and to try new things!
Tip : If you ’re still uncom fo rtable exe rcising in the pre sence of str ange rs, go with a group of friends. . . Having a collective
gro up a round ma y put you mo re at e ase with exerc ising, yo ur se lf-confid ence is like ly to im prove as we ll.
Social Factors
Get familiar with the Athletic Ce ntre (AC) or Hart House . Ther e are a varie ty of gr oup exercise classe s, sport team s, and
gym fa cilitie s that are offe red . The best part of it, YO U’VE ALREADY PAID FO R IT!!
Get soc ial. You may d o better with enco urageme nt from o the rs. Create groups or clubs— Run ning/ Cycling clubs, Danc ing
gro ups
Jo in a te am. Sign up for a so ftball, socce r or volleyball tea m thr ough IN TRAMURA LS, o r comm unity clubs within the
Toron to do wnto wn a rea. Co mmitting to a te am is a gr eat motivator !
Plan active o utings. Utilizing the la rge group within the reside nce will help you m eet new peo ple, and c reate op por tun ities to
do fun activities.
Health-Related
Feeling Sick? Rule of thumb: You may proc eed with your workout if your signs and symptom s ar e "ab ove the ne ck" ( e. g. ,
runny no se, nasal congestion, sne ezing or sor e th roat), DON ’T IF yo ur signs an d symp to ms are "b elow the ne ck" (e .g., ch est
congestio n, hac king cough o r up set stom ach) .
If you choo se to e xercise when yo u're sick, listen to yo ur bo dy. If your signs and symptoms get wo rse with physic al activity,
stop and re st. Resume your workout routine gradually as you begin to fe el be tte r.
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Ph.D. Dissertation – M. Kwan
Goal Setting— helping you be more active
Principles of S.M.A.R.T. goal setting

Pinpoint your ultimate goal.

Break down your ultimate goal into small, specific and achievable m ini-goals.

Monitor your progress regularly.

Adapt your goals to fit changing circumstances.
Don’t get down on yourself or give up if you fall short. Stay Positive!

Make your goals known to others.

Include a reward in your goal-setting process. Plan for how you will benefit if you
meet this goal.
Example Goal setting
Specific: I will go for 5km run 3 times a week; and to complete the 5km under 30
minutes
Measurable: I will time myself each time I go running and will keep a running log
Attainable: To achieve my overall goal, I will outline specific targets
To begin, my pace will be slower, but my short term goal is to run 5km without stop ping
After four weeks, I want to run 5km under 40 minutes
After six weeks, I want to reach my GOAL of running 5km under 30 minutes
** these targ ets need to be re-evaluated, and can be adjusted (whether it
means taking longer to reach your goal, or reaching your goal quicker than you had
anticipated)
Realistic: Be honest when setting a goal that will be achievable. I feel a 5km run in under 30
minutes is an achievable goal, ONLY after 6 weeks of training for this.
Time oriented: Reach 30 minutes p er session by 6 weeks.
Rememb er that you may encounter difficulties getting to your goal
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Ph.D. Dissertation – M. Kwan
Goal Setting— Tips for successful goal setting
Pinpoint your goal

Be realistic. Your ultimate goal could be to be fit enough to participate in a competition or to be
more active than you currently are. Whatever the case, make this goal realistic. Think about what
is achievable for you.

Don’t make your ultimate goal a general statement like: ‘I want to lose weight’. Be specific. Make
it measurable. Exactly how much weight do you want to lose?

Choose a goal that is meaningful and important to you.
Set small, specific mini-goals
You are more likely to reach your ultimate goal if you break it down into small and specific mini-goals.
Suggestions include:

Set a reasonable time frame. For example, if you want to participate in a “5km race”, then a
realistic goal and timetable to train appropriately.

Consider your exercise routines as mini-goals. For example, one mini-goal might be based on
running, while your other is based on swimming.

Mini-goals should be set for every week. The more mini-goals you achieve, the more motivated
you will become.
THINGS TO RE MEMBE R:
Break do wn yo ur ultima te goa l int o small, specific a nd achie va ble mini-go als.
Ke ep a tra ining dia ry t o mo nitor your pr ogr ess.
Yo ur goa l should a lso include HA VI NG FUN!
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Ph.D. Dissertation – M. Kwan
Monitor your progress regularly
Make your mini-goals measurable. Decide how you are going to monitor your progress
and record every detail in a training diary. You can also use Action Planning for this.

Write down your progress as you go (i.e., for intervals such as once a week).

Find as many different ways to monitor your progress as you can. For example, if
you are training for your 5km race, record what you are doing to train (i.e.,
distance, times). Include incidental achievements like feeling more energetic, or
completing a big climb. The idea is to give yourself plenty of ways to succeed.
Adapt to changing circumstances
Life can interrupt your activity schedule.

Think about ways to cope with interruptions. For example, you may not be able to
exercise in your usual way when it is exam time, so you may do less in those one
or two weeks, BUT try and regain your routine as soon as possible.

If you get injured or ill, don’t abandon your goals. Instead, adjust your ultimate
goal’s time frame. Come up with mini-goals to keep you on track while you
recover.

You may find that you achieve your goal earlier than expected. Go ahead and set
another goal.

If your goal seems too far out of reach, set your sights a little lower and stay
motivated.
Don’t be too hard on yourself
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Ph.D. Dissertation – M. Kwan
G
Get A
Acttive, Yourr Way, E
Every Dayy!
SUNDAY
MONDAY
Place (P): Pool
Time (T): 7pm
Minutes (M): 40
Activity (A): swim
Cue (C): place
goggles on desk in
the morning
This is an example plan formed by a
first-year university student who wanted
to include more activity into her lifestyle.
P: Campus
T: 12pm
M: 30
A: Run with Rita
C: running shoes
on top of school
bag Sunday
evening
TUESDAY
P: Gym
T: 6pm
M: 60
A: yoga
C: Set my phone
alarm to buzz at
5:00pm as a reminder
S
Yoouu
Heellpp Y
Maayy H
at M
Sttrraatteeggiieess TThhaat
mee S
Soom
St rategy 1:
Form a Weekly A ct ion Pl an
St rategy 2:
Use Action Cues
Strategy 3:
Pre
repare O ne Step at a Ti me
Form a realistic weekly physical activity plan.
These plans should be specific and include the
da y, time and location as well as what you
plan on doing – give it a try.
A cue refers to a memory trigger for a planned
behaviour. For example, placing your running
shoes on top of your school bag the night
before can act as a reminder for you to bring
your shoes for a lunchtime walk/jog. Cues
may not be necessary once activities become
habitual.
Focus on getting ready. For instance, instead of
thinking about going for a jog and all that’s
invo lved, focus on getting your workout clothes
and shoes on and getting out the door. The rest
will go from there.
To start, plan to be active at least for 4 days each week…
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
P:
P:
P:
P:
P:
P:
P:
T:
T:
T:
T:
T:
T:
T:
M:
M:
M:
M:
M:
M:
M:
A:
A:
A:
A:
A:
A:
A:
C:
C:
C:
C:
C:
C:
C:
Now t hat you’ ve had some practi ce, use the calendar on the back of this page t o pl an your physical act ivity
for the next month.
230
Strategy 1
One strateg
increase phy
activity plan.
day, time a
activity as we
Strategy 2
Another strat
getting ready
a jog and al
clothes and s
from there.
Ph.D. Dissertation – M. Kwan
M
Myy pphhyyssiiccaall aaccttiivviittyy ppl
pl aann ffoorr tthhee m
moonntthh ooff ________________________________________.
_.
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
P:
P:
P:
P:
P:
P:
P:
T:
T:
T:
T:
T:
T:
T:
M:
M:
M:
M:
M:
M:
M:
A:
A:
A:
A:
A:
A:
A:
C:
C:
C:
C:
C:
C:
C:
P:
P:
P:
P:
P:
P:
P:
T:
T:
T:
T:
T:
T:
T:
M:
M:
M:
M:
M:
M:
M:
A:
A:
A:
A:
A:
A:
A:
C:
C:
C:
C:
C:
C:
C:
P:
P:
P:
P:
P:
P:
P:
T:
T:
T:
T:
T:
T:
T:
M:
M:
M:
M:
M:
M:
M:
A:
A:
A:
A:
A:
A:
A:
C:
C:
C:
C:
C:
C:
C:
P:
P:
P:
P:
P:
P:
P:
T:
T:
T:
T:
T:
T:
T:
M:
M:
M:
M:
M:
M:
M:
A:
A:
A:
A:
A:
A:
A:
C:
C:
C:
C:
C:
C:
C:
Strat egy 2
Another strate
getting ready.
a jog and all
clothes and sh
from there.
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Ph.D. Dissertation – M. Kwan
Appendix C.2 – Pre-Testing Letter of Information and Consent
Letter of Information
“Bridging the Intentions-Behaviour Gap during Transition into University: Evaluating a Pilot Physical
Activity Intervention for First-Year Students ”
Dear Study Participant:
Overview: Thank you for taking part in the study “Bridging the Intentions-Behaviour Gap during
Transition into University: Evaluating a Pilot Physical Activity Intervention for First-Year
Students”. As a part of my PhD work (funded by the Social Sciences and Humanities Research
Council), you are being asked to take part in the pre-testing for a pilot intervention study. A
community on Blackboard has been set up, and your help is required in determining whether
changes are needed. Your participation is voluntary, and you may withdraw from this study at
any time without consequence.
Procedure: You will be invited to the Exercise Psychology Unit lab, where the webpage will be
set up for you to go through. In addition to viewing the information on the website, you will be
asked to navigate to a specified area on the webpage, and to complete an action planning task,
and to complete a short questionnaire. An observer will be present to assist, should you have any
difficulties. Should you wish to obtain a copy of the results from the study, please feel free to
contact me at any time.
Risk/Benefits: There is little risk associated with your participation. The material on the webpage
will be general physical activity information, and the questionnaires will not be intrusive or
sensitive by nature. The purpose of this intervention is to help university students maintain a
physically active lifestyle, and to determine whether this type of intervention is effective. The
information may also provide you with some new knowledge and information around
maintaining a physically active lifestyle. Your participation is important, and we would like to
assure you that any personal information you provide will be kept confidential. Any data
obtained will be housed within the Exercise Psychology Lab, only available to members of the
research team.
We want to thank you for your participation. If you have any further questions about your rights
as a research participant, please contact Zaid Gabriel, Research Ethics Review Officer, Health
Services [email protected] or (416)946-5806.
Sincerely,
Mr. Matthew Kwan, Ph.D. Candidate
Department of Exercise Sciences
University of Toronto
Phone: (416) 978-7571 E-mail: [email protected]
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Ph.D. Dissertation – M. Kwan
Consent
I consent to participate in this pilot intervention study entitled “Bridging the IntentionsBehaviour Gap during Transition into University: Evaluating a Pilot Physical Activity Intervention
for First-Year Students” as described in the letter of information.
Printed Name: __________________________ Signature: _____________________________
Date: _________________________________________
Mr. Matthew Kwan, Ph.D. Candidate
Department of Exercise Sciences
University of Toronto
Phone: (416) 978-7571 E-mail: [email protected]
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Ph.D. Dissertation – M. Kwan
Appendix C.3 – Pre-Testing Acceptability Questionnaire
Using the scale below, please complete the following questions:
1
Strongly
disagree
2
Moderately
disagree
3
4
5
Slight ly
disagree
Neither
Sl ightly
agree
6
Moderately
agree
7
Strongly
agree
1. Overall, I found the web-based format to be informative
1
2
3
4
5
6
7
2. Overall, I found the web-based format to be appropriate in tone and language
1
2
3
4
5
6
7
6
7
5
6
7
5
6
7
5
6
7
5
6
7
5
6
7
5
6
7
5
6
7
5
6
7
5
6
7
5
6
7
5
6
7
6
7
6
7
3. Overall, I found the web-based format to be graphically appealing
1
2
3
4
5
4. Overall, I found the web-based format was easy to navigate
1
2
3
4
5. I think the physical activity advice is credible
1
2
3
4
6. I think the physical activity advice is personally relevant or useful
1
2
3
4
7. I think the physical activity advice is interesting
1
2
3
4
8. I think the physical activity advice is logical
1
2
3
4
9. I think the physical activity advice is comprehensible
1
2
3
4
10. I think the physical activity advice is well-styled
1
2
3
4
11. I think the physical activity advice is complete
1
2
3
4
12. I think the physical activity advice is instructive
1
2
3
4
13. I think the physical activity advice is too long
1
2
3
4
14. I think the physical activity advice is too confusing
1
2
3
4
15. I think the physical activity advice gives too much information
1
2
3
4
5
16. The website’s content was clearly targeting university students
1
2
3
4
234
5
Ph.D. Dissertation – M. Kwan
Overall, I think the website could be useful for helping me be physically active…
1
Strongly
disagree
2
Moderately
disagree
3
Slightly
disagree
4
Neither
Suggestions for enhancements:
Suggestions for deletions:
Suggestions for additions:
235
5
Slightly
agree
6
Moderately
agree
7
Strongly
agree
Ph.D. Dissertation – M. Kwan
Appendix C.4 – Pre-Testing Usability Questionnaire
1
2
Very
difficult
3
Difficult
4
Somewhat
difficult
5
Neither
6
7
Somewhat
easy
Easy
Very
easy
5
6
7
5
6
7
6
7
5
6
7
4
5
6
7
4
5
6
7
5
6
7
1. Finding September 20 on the calendar was…
1
2
3
4
2. Finding the health benefits of physical activity was…
1
2
3
4
3. Finding the link to more information on the Athletic Centre was…
1
2
3
4
5
4. Finding the tips on coping with physical activity barriers was…
1
2
3
4
5. Finding the link to Sweat Magazine was…
1
2
3
6. Adding to the discussion board was…
1
2
3
7. Finding the information on action planning was…
1
2
3
4
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Ph.D. Dissertation – M. Kwan
Appendix C.5 – Efficacy Trial Letter of Information and Consent
Letter of Information
“Bridging the In tentions-Behavio ur Gap during Transition into Un iversity: Evaluating a Pilot Physical
Activity Intervention for First-Year Students ”
Dear Study Participant:
Overview: Thank you for taking part in the study “Bridging the Int entions-B ehav iour Ga p during
Transition int o University: E valua ting a Pilot Physical Activity Intervention fo r First-Yea r
Students ”. As a part of my PhD work (funded by the Social Sciences and Humanities Research
Council), you are being asked to take part in a pilot intervention study. A community on
Blackboard has been set up, as an informational resource for you to use. It is entirely up to you
how often you enter this webpage; and please note you may terminate your participation in this
study at any time without consequence.
Procedure: You will have access to the Portal community for you to use at any point. In
addition, there will be a series of (3) questionnaires administered to you via e-mail. Each
questionnaire will take approximately 5-10 minutes to complete, and all information will be
retained on a secure university server. In November, you will also receive an invitation to take
part in a 60 minute focus group, to discuss your thoughts around the physical activity
intervention. Participation in the focus group will be strictly voluntary. Should you wish to
obtain a copy of the results from the study, please feel free to contact me at any time.
Risk/Benefits: There is little risk associated with your participation. The material on the webpage
will be general physical activity information, and the questionnaires will not be intrusive or
sensitive by nature. For the residence group that yields the highest completion rate at the end of
the intervention, they will receive a dinner party. Additionally, for completing each of the
questionnaires, you will also be eligible to win 1 of 4 gift certificates to the University of Toronto
bookstore (value $25). The purpose of this intervention is to help you maintain a physically
active lifestyle during the transition into university, and to determine whether this type of
intervention is effective. Your participation is important, and we would like to assure you that
any personal information you provide will be kept confidential. Your personal information will
not be identified in any documents, and any data obtained will be housed within the Exercise
Psychology Lab, only available to members of the research team.
We want to thank you for your participation. If you have any further questions about your rights
as a research participant, please contact Zaid Gabriel, Research Ethics Review Officer, Health
Services [email protected] or (416)946-5806.
Sincerely,
Mr. Matthew Kwan, Ph.D. Candidate
Department of Exercise Sciences
University of Toronto
Phone: (416) 978-7571 E-mail: [email protected]
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Ph.D. Dissertation – M. Kwan
Consent
I consent to participate in this pilot intervention study entitled “Bridging the IntentionsBehaviour Gap during Transition into University: Evaluating a Pilot Physical Activity Intervention
for First-Year Students” as described in the letter of information.
Printed Name: __________________________ Signature: _____________________________
Date: _________________________________________
Mr. Matthew Kwan, Ph.D. Candidate
Department of Exercise Sciences
University of Toronto
Phone: (416) 978-7571 E-mail: [email protected]
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Ph.D. Dissertation – M. Kwan
Appendix C.6 – Efficacy Trial Baseline Questionnaire
Physical Activity Questionnaire, Septem ber 2009
Your name and e-mail: [required in order to match your future questionnaire(s)]
First and Last Name:
E-mail Address:
1. What is your year of study?  1
st
2
nd
3
2. When did you graduate from high school?  Spring 2009
rd
4
th
Other
 Other
3. Which city was your high school located?
years
4. Age:
5. Sex:
 Female
 Male
6. Ethnicity:
 Caucasian
 Black not-Hispanic
Asian
 Multiracial
 North American Indian/Alaskan Native
Hispanic
Other
7. Which residence building do you reside in?
11. What grade(s) did you take Physical Education in high school? (check ALL those that apply
 grade 9
 grade10
 grade 11
239
 grade 12
Ph.D. Dissertation – M. Kwan
For the next 2 questions:
Recall your average weekly participation in physical activity during the last 7 months (since January,
2009)
1) In a usual week, how many DAYS and how much TIME do you do vigorous activities for at
least 10 minutes at a time (such as running, aerobics, hockey, squash, rollerblading) that causes
large increases in breathing or heart rate?
How many days per week do you
participate in vigorous activities
lasting 10 minutes or longer?
On those days, how much total time per day do
you spend doing these activities?
DAYS
Hour(s)
Minute(s)
2) In a usual week, how many DAYS and how much TIME do you do moderate activities for at
least 10 minutes at a time (such as brisk walking, bicycling, easy swimming, volleyball) that causes
small increases in breathing or heart rate?
How many days per week do you
participate in moderate activities
lasting 10 minutes or longer?
On those days, how much total time per day do
you spend doing these activities?
DAYS
Hour(s)
240
Minute(s)
Ph.D. Dissertation – M. Kwan
We are going to ask you about your beliefs regarding physical activity, and what you think about them
within the context of the next 6 weeks.
In accordance with the Health Canada guidelines, being “physically active” is defined as having 4 OR
MORE days of vigorous or moderate levels of activity for an accumulated time of 30 minutes or more
each day.
Moderate-intensity exercise is defined as fast walking, tennis, easy bicycling, easy swimming, or dancing
Such exercise may work up a light perspiration but is not exhausting. Accumulating 30 minutes of
moderate-intensity exercise could be achieved with one brisk 30-min walk or in shorter bouts (for example
three 10-min walks).
Vigorous-intensity exercise is defined as running, aerobics, hockey, squash or rollerblading. Such exerci
causes larger increases in breathing or heart rate.
Please keep in mind the Health Canada guidelines when answering the following questions. Use the
scales below to answer each of the following questions.
During the next 6 weeks…
being physically active for me will be…
1
2
3
Extreme ly
unenjoyable
Quite
unenjoyable
Slightly
unenjoyable
being physically active for me will be…
1
2
3
Extreme ly
useful
Quite
useful
Slightly
useful
being physically active for me will be…
1
2
3
Extreme ly
harmful
Quite
harmful
Slightly
harmful
being physically active for me will be…
1
2
3
Extreme ly
unpleasant
Quite
unpleasant
Slightly
unpleasant
being physically active for me will be…
1
2
3
Extreme ly
boring
Quite
boring
Slightly
boring
being either physically for me will be…
1
2
3
Extreme ly
Good
Quite
good
Slightly
good
4
5
Neither
Slightly
enjoyable
6
Quite
enjoyable
4
5
6
Neither
Slightly
useless
Quite
useless
4
5
Neither
Slightly
beneficial
4
5
Neither
Slightly
pleasant
6
Quite
beneficial
6
Quite
pleasant
4
5
6
Neither
Slightly
fun
Quite
fun
4
5
6
Neither
Slightly
bad
Quite
bad
241
7
Extremely
enjoyable
7
Extremely
useless
7
Extremely
beneficial
7
Extremely
pleasant
7
Extremely
fun
7
Extremely
bad
Ph.D. Dissertation – M. Kwan
important people to me think I should be physically active …
1
2
3
4
5
Strongly
disagree
Moderately
disagree
Slightly
disagree
Neither
Slightly
agree
how confident are you that you that you can be physically active …
1
2
3
4
5
Extremely
unconfident
Quite
unconfident
Slightly
unconfident
for me to be physically active …
1
2
3
Extremely
difficult
Quite
difficult
Slightly
difficult
Neither
Moderately
disagree
Slightly
disagree
4
5
6
Slightly
easy
Quite
easy
Neither
how much control do you have to be physically active …
1
2
3
4
Extreme lack
of control
Moderate lack
of control
Slight lack
of control
Neither
5
Slightly
agree
5
Slight
control
it is completely up to me whether or not I am physically active …
1
2
3
4
5
Strongly
disagree
Moderately
disagree
Slightly
disagree
Neither
Slightly
agree
it is beyond my control whether or not I am physically active …
1
2
3
4
5
Strongly
disagree
Moderately
disagree
Slightly
disagree
I intend to be physically active …
1
2
3
Strongly
disagree
Moderately
disagree
Slightly
disagree
I will try to be physically active …
1
2
3
Strongly
disagree
Moderately
disagree
Slightly
disagree
It is my desire to be physically active …
1
2
3
Strongly
disagree
Moderately
disagree
Slightly
disagree
6
Quite
confident
Neither
if I wanted to, I could easily be physically active …
1
2
3
4
Strongly
disagree
Slightly
confident
6
Moderately
agree
Neither
Slightly
agree
4
5
Neither
Slightly
agree
4
5
Neither
Slightly
agree
4
5
Neither
Slightly
agree
242
6
Moderately
agree
6
Moderate
control
6
Moderately
agree
6
Moderately
agree
6
Moderately
agree
6
Moderately
agree
6
Moderately
agree
7
Strongly
agree
7
Extremely
confident
7
Extremely
easy
7
Strongly
agree
7
Extreme
control
7
Strongly
agree
7
Strongly
agree
7
Strongly
agree
7
Strongly
agree
7
Strongly
agree
Ph.D. Dissertation – M. Kwan
Appendix C.7
Physical Activity Questionnaire, November 2009
Your name and e-mail: [required in order to match your previous and future questionnaire(s)]
First and Last Name:
E-mail Address:
For the next 2 questions:
Recall your average weekly participation in physical activity during the last 6 weeks (since September,
2009)
1) In a usual week, how many DAYS and how much TIME do you do vigorous activities for at
least 10 minutes at a time (such as running, aerobics, hockey, squash, rollerblading) that causes
large increases in breathing or heart rate?
How many days per week do you
participate in vigorous activities
lasting 10 minutes or longer?
On those days, how much total time per day do
you spend doing these activities?
DAYS
Hour(s)
Minute(s)
2) In a usual week, how many DAYS and how much TIME do you do moderate activities for at
least 10 minutes at a time (such as brisk walking, bicycling, easy swimming, volleyball) that causes
small increases in breathing or heart rate?
How many days per week do you
participate in moderate activities
lasting 10 minutes or longer?
On those days, how much total time per day do
you spend doing these activities?
DAYS
Hour(s)
Minute(s)
We are going to ask you about your beliefs regarding physical activity, and what you think about them
within the context of the next 6 weeks.
In accordance with the Health Canada guidelines, being “physically active” is defined as having 4 OR
MORE days of vigorous or moderate levels of activity for an accumulated time of 30 minutes or more
each day.
Moderate-intensity exercise is defined as fast walking, tennis, easy bicycling, easy swimming, or dancing.
Such exercise may work up a light perspiration but is not exhausting. Accumulating 30 minutes of
moderate-intensity exercise could be achieved with one brisk 30-min walk or in shorter bouts (for example,
three 10-min walks).
243
Ph.D. Dissertation – M. Kwan
Vigorous-intensity exercise is defined as running, aerobics, hockey, squash or rollerblading. Such
exercise causes larger increases in breathing or heart rate.
Please keep in mind the Health Canada guidelines when answering the following questions. Use
the scales below to answer each of the following questions.
During the next 6 weeks…
being physically active for me will be…
1
2
3
Extremely
unenjoyable
Quite
unenjoyable
Slightly
unenjoyable
being physically active for me will be…
1
2
3
Extremely
useful
Quite
useful
Slightly
useful
being physically active for me will be…
1
2
3
Extremely
harmful
Quite
harmful
Slightly
harmful
being physically active for me will be…
1
2
3
Extremely
unpleasant
Quite
unpleasant
Slightly
unpleasant
being physically active for me will be…
1
2
3
Extremely
boring
Quite
boring
Slightly
boring
being either physically for me will be…
1
2
3
Extremely
Good
Quite
good
Slightly
good
4
5
Neither
Slightly
enjoyable
4
5
6
Neither
Slightly
useless
Quite
useless
4
5
Neither
Slightly
beneficial
4
5
Neither
Slightly
pleasant
Moderately
disagree
Slightly
disagree
Quite
unconfident
Slightly
unconfident
6
Quite
pleasant
4
5
6
Slightly
fun
Quite
fun
4
5
6
Neither
Slightly
bad
Quite
bad
Neither
Slightly
agree
how confident are you that you that you can be physically active …
1
2
3
4
5
Extremely
unconfident
6
Quite
beneficial
Neither
important people to me think I should be physically active …
1
2
3
4
5
Strongly
disagree
6
Quite
enjoyable
Neither
244
Slightly
confident
6
Moderately
agree
6
Quite
confident
7
Extremely
enjoyable
7
Extremely
useless
7
Extremely
beneficial
7
Extremely
pleasant
7
Extremely
fun
7
Extremely
bad
7
Strongly
agree
7
Extremely
confident
Ph.D. Dissertation – M. Kwan
for me to be physically active …
1
2
3
Extremely
difficult
Quite
difficult
Slightly
difficult
4
5
6
Neither
Slightly
easy
Quite
easy
if I wanted to, I could easily be physically active …
1
2
3
4
Strongly
disagree
Moderately
disagree
Slightly
disagree
Neither
5
how much control do you have to be physically active …
1
2
3
4
Extreme lack
of control
Moderate lack
of control
Slight lack
of control
Neither
6
Slightly
agree
Moderately
agree
5
6
Slight
control
Moderate
control
it is completely up to me whether or not I am physically active …
1
2
3
4
5
Strongly
disagree
Moderately
disagree
Slightly
disagree
Neither
6
Slightly
agree
Moderately
agree
it is beyond my control whether or not I am physically active …
1
2
3
4
5
Strongly
disagree
Moderately
disagree
Slightly
disagree
Neither
I intend to be physically active …
1
2
3
Strongly
disagree
Moderately
disagree
Slightly
disagree
I will try to be physically active …
1
2
3
Strongly
disagree
Moderately
disagree
Slightly
disagree
It is my desire to be physically active …
1
2
3
Strongly
disagree
Moderately
disagree
Slightly
disagree
6
Slightly
agree
4
5
Neither
Slightly
agree
4
5
Neither
Slightly
agree
4
5
Neither
Slightly
agree
Moderately
agree
6
Moderately
agree
6
Moderately
agree
6
Moderately
agree
7
Extremely
easy
7
Strongly
agree
7
Extreme
control
7
Strongly
agree
7
Strongly
agree
7
Strongly
agree
7
Strongly
agree
7
Strongly
agree
Please indicate your CONFIDENCE IN YOUR ABILITIES
0
1
Not at all
confident
2
3
4
5
Somewhat
confident
6
7
8
9
10
Completely
confident
How confident are you to be able to continue your regular physical activity routines following
periods of disruptions and increased workloads (e.g., weeks that you are less active due to exams
and/or reading breaks)?
245
Ph.D. Dissertation – M. Kwan
Appendix C.8 – Formative Evaluation Focus Group Schedule
Follow-up Intervention-- focus group interview schedule
Introduction
Hi everyone. Thank you for taking part in my study, including with this focus group. The
information that I am getting from you is really important, and I certainly appreciate you taking
the time to help me out. The purpose of this focus group is for you to provide some
feedback/input on the Blackboard/Portal community that I had developed for you.
First, we will start by talking about some of your general impressions of the website intervention.
Secondly, I want to know what you thought of its accessibility. Lastly, I want to get your
feedback on how this type of intervention can be improved.
General Impressions
As I have explained to you during the floor meetings, most of the research I have been associated
with has been around the declines in physical activity levels during students’ transition into
university—and the reason why I wanted to develop the Blackboard community for you. So now
that you had the opportunity to use it, I want to get some initial thoughts on what you thought
[think] of it…

The content
o Did I have the right information?
o What kind of information did you like?
o What kind of information would you have preferred to have seen?

The aesthetics
o Did it look good?
o Is it something that a typical university student sees as ‘cool’?
Access to Community
Now I want to ask you what you thought about the accessibility of Blackboard community…

How much did you guys access the community?
o What could attract you to access it more?
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Ph.D. Dissertation – M. Kwan

How about weekly e-mail reminders and weekly announcements being posted?
o Some of you had a weekly e-mail sent to you—did you like this?
o Did this prompt you to check the community out?
Future Directions
The real purpose of this is to understand how we can improve this intervention. We want to
know what we can do to help future university students be more physically active.

Is this a tool that we should use to reach students?

So what do you think we need to do better?
o We had a discussion about the potential for additional information that could be
added, can you think of anything else?
o Is there anything we can do to make it more user-friendly?
o What would have made you or kept you more interested in this?

How do we get others students more engaged in something like this?
That concludes the focus group. I want to once again thank you for participating in this study.
Also, I want to assure you that this information will be treated with strict confidentiality, and if
you wish see the results from this study, please contact me. Thank you for your time!
247