Considering the role of physical activity on public health and the high prevalence of physical inactivity worldwide, determining physical activity barriers is critical and will be a road map for future planning. This study aimed to develop a comprehensive questionnaire to determine physical activity barriers.
By reviewing previous studies, the main domains of the questionnaire were established. A physical activity expert interviewed 20 individuals aged 18 to 65 years. The results were evaluated by an expert panel for a content validity index. Face validity, test-retest reliability, and internal consistency were established on 204 individuals.
The content validity index in all items was within the acceptable range (>0.85). Face validity was appropriate, and the misunderstanding index was < 20% in all items. Test-retest reliability in the final questionnaire in all items based on Cohen’s kappa was > 0.20, indicating fair agreement. Internal consistency with Cronbach’s alpha of 0.63 was within the acceptable range.
The study revealed that the newly designed survey is valid, accurate, and reliable. The use of this comprehensive tool by policymakers would help them properly identify the perceived barriers, and thus perform better physical activity interventions as promotional health programs.
Physical activity(PA) is defined as any body movement produced by skeletal muscle contraction which mandates energy consumption [
The socio-ecological model suggests that intrapersonal, interpersonal, and environmental domains determine individuals’ PA levels [
Different studies have been conducted to determine the motivators and PA barriers in various populations [
The study was conducted between February 2021 and July 2021. All participants were provided with comprehensive details regarding the study’s objective and asked to sign an informed consent form. This study was conducted in accordance with the Declaration of Helsinki, and the Tehran University of Medical Sciences ethics committee approved the study protocol (ethics code: IR.TUMS. NI.REC.1399.019).
The study was performed in two stages. First, the initial version of the questionnaire was developed. Second, the reliability and validity of the questionnaire were evaluated, and it was finalized.
The scope of the questionnaire’s content, including PA barriers, was established by reviewing previous studies. A clear description of PA barriers was established, existing questionnaires were assessed, and the main PA barriers based on the current literature were established. Main domains of PA barriers and existing cognitive and transtheoretical features, including socioeconomic, cultural, individual, and environmental barriers, were established.
Twenty individuals, aged between 18 to 65 years were interviewed by a PA expert, individually. PA was defined as any movement of the individual’s body produced by skeletal muscles, leading to energy consumption. PA could be engaged in various domains, including work-related, housekeeping, travel, recreational activities, and sports in daily living. A principal PA expert conducted all interviews. Participants were encouraged to discuss the PA barriers in their daily lives. The duration of each interview session was between 30 to 60 minutes. All sessions were audio-recorded and accurately transcribed. The main domains for PA barriers were applied during the sessions to guide the interview, and further details were obtained and recorded following each session. The results of the interviews were analyzed and included in the questionnaire. The principal concepts were obtained from the interviews, and personal information was omitted. All statements were indexed, and the questionnaire was reorganized according to indexes. Statements from the interviews were added with a clear, simple, and intelligible structure.
An expert panel was developed, consisting of seven members with at least 5 years of experience in the PA research, executive, or governance domain. The expert panel members were specialists in sports medicine, physical education, and psychology. The questionnaire’s content was assessed and screened by the expert panel in detail. The content validity index (CVI) was applied to evaluate the validity. The expert panel assessed each statement and scored the items based on the relevance of each statement to the purpose of the project (1 = not relevant, 2 = major revision is required to induce relevance, 3 = minor revision is required to induce relevance, 4 = highly relevant). CVI for each statement was established based on experts’ opinions, and statements were revised or omitted if they did not reach the minimum score required [
A pilot study was conducted on 204 individuals aged 18 to 65 years with the ability to engage in PA and the desire to participate in the study. We designed an online form containing the questionnaire and questions regarding the eligibility of participants. We used convenience and snowball sampling methods to recruit the individuals. Face validity was established via interviewing 20 individuals, and the misunderstanding index was established for each statement. The acceptable misunderstanding index for any statement was < 20% and if the item did not meet the cut-off, it was omitted. Test-retest reliability was assessed considering 56 individuals with a 2-week interval. Internal consistency was established by calculating Cronbach’s alpha.
If the CVIbased on the expert panel’s opinion was a minimal 0.83, it was considered acceptable [
The data that support the findings of this study are available upon reasonable request.
In total, 204 individuals participated in the study, of which, 56 participants completed the questionnaire in the second round.
We performed EFA to determine the factor structure of the questionnaire. There were nine factors with an eigenvalue > 1. However, only one of these factors could explain > 10% of the variance (
Regular PA might be challenged due to the fact that perceived barriers may lead to significant preventive health behaviors. It seems that barrier identification could promote exercise participation [
The aim of this study is twofold. First, in phase one, we developed a self-administered questionnaire-based tool to assess PA barriers. Second, in phase two, the reliability and validity of the questionnaire were assessed.
Our results revealed that the final 21-item questionnaire comprehensively focused on socioeconomic, cultural, personal, and environmental factors as barrier domains. The initial draft of the tool was considered a 32-item questionnaire. Although excluded items due to either low kappa or low CVI were mainly related to the personal domain, the remaining questions seemed to cover this domain adequately. Therefore, the final items were sorted into the same four axes mentioned above. This 21-item survey was found to have an acceptable internal consistency as assessed by measuring Cronbach’s alpha.
Concerning the importance of PA barriers, various questionnaires have been developed to assess these barriers among healthy and unhealthy populations [
Exercise benefits and barriers scale (EBBS) has been developed to measure the benefits of and barriers to exercise among the healthy population by Sechrist et al. [
In a 2015 study, Joseph et al. categorized PA barriers among women as interpersonal, intrapersonal, or environmental determinants [
The main content of the current questionnaire was developed following literature review. Lack of time and motivation and safety concerns were consistently cited as PA barriers [
Within the domain of environmental factors, the framework suggested by Pikora et al. was considered. The proposed environmental domains comprised multiple subdomains. Accessibility to exercise facilities, structural features, and safety and aesthetic qualities were reviewed as important subdomains in this regard [
Using self-administered rather than interview-based questionnaires can minimize costs [
The limitation of this tool is that it is developed for the healthy adult population. Thus, the generalization of its use to other populations may be unwarranted. Future studies should aim to evaluate the psychometric features of this instrument among other populations to generalize its application.
In conclusion, this study revealed that the newly designed survey is valid, accurate, and reliable. The use of this comprehensive tool by policymakers would help them properly identify the perceived barriers and thus perform better PA interventions as promotional health programs.
Flow diagram of the study.
Scree plot of final 20 items.
Participants’ responses to each item of the final version of the questionnaire in the first and second rounds of the study and their agreement on each item.
Item | Answer | First round (N=204) | Second round (N=56) | Kappa |
---|---|---|---|---|
Initial item. In general, do you want to spend more time on exercising and engaging in physical activities than you do now (compared to the current situation)? | Yes | 189 (92.6%) | 53 (94.6%) | 0.486 |
1. Suitable facilities or places for engaging in physical activity, exercise, and sports that I am interested in, are unavailable. | Yes | 55 (27%) | 11 (19.6%) | 0.231 |
2. The physical activities or sports that I am interested in are expensive. | Yes | 24 (11.8%) | 8 (14.3%) | 0.769 |
3. Addressing other issues (job-related, family, etc.) is a priority rather than exercise and physical activity. | Yes | 99 (48.5%) | 36 (64.3%) | 0.479 |
4. I prefer to spend my time on other recreational activities, including music, movies, theater, computer games, travel, food, study, spending time with friends, etc. | Yes | 40 (19.6%) | 16 (28.6%) | 0.41 |
5. I am very tired and do not have enough energy to do physical activity and exercise. | Yes | 64 (31.4%) | 27 (13.2%) | 0.425 |
6. I can hardly motivate myself to do exercise and physical activity. | Yes | 48 (23.5%) | 21 (37.5%) | 0.49 |
7. My hair, clothes, and shoes get damaged during physical activity and exercise. | Yes | 7 (3.4%) | 2 (3.6%) | 0.481 |
8. I am not physically fit enough to do physical activity and exercise. | Yes | 24 (11.8%) | 13 (23.2%) | 0.463 |
9. I was injured during exercise and physical activity, and I do not want to get injured again. | Yes | 7 (3.4%) | 1 (1.8%) | 0.659 |
10. I have an injury (not induced by exercise), and I cannot do physical activity and exercise. | Yes | 7 (3.4%) | 1 (1.8%) | 0.382 |
11. I am disabled and unable to do physical activity and exercise. | Yes | 1 (0.5%) | 1 (1.8%) | 1 |
12. I have a medical condition, and I cannot do exercise and physical activity due to my health problem. | Yes | 4 (2%) | 3 (5.4%) | 0.791 |
13. I do not feel safe while doing physical activity and exercise. | Yes | 6 (2.9%) | 3 (5.4%) | 0.296 |
14. I do not have enough self-confidence for physical activity and exercise. | Yes | 15 (7.4%) | 7 (12.5%) | 0.256 |
15. People around me forbid or prevent me from doing sports and physical activity. | Yes | 6 (2.9%) | 1 (1.8%) | 0.659 |
16. I do not have anyone to do sports and physical activity with, who would accompa- ny me. | Yes | 49 (24%) | 20 (35.7%) | 0.3 |
17. I do not like other people to see me exercising. | Yes | 10 (4.9%) | 3 (5.4%) | 0.732 |
18. Doing physical activity and exercise is boring. | Yes | 6 (2.9%) | 1 (1.8%) | 0.382 |
19. The air and environment are hot, polluted, and unsuitable. | Yes | 36 (17.6%) | 10 (17.9%) | 0.507 |
20. There is no suitable exercise counselor or physical activity specialist in the gym to advise, help, and consult individuals. | Yes | 19 (9.3%) | 6 (10.7%) | 0.496 |