This study explored the physical activity behaviour and influencing factors in this vulnerable and hard to reach age group. Included were, not only 18–25
year olds from university and colleges but also those who were working and those not in education, employment or training (NEET groups). The mixed method study design identified factors affecting behaviour and unravelled details of these and other factors affecting behaviour through interactive focus groups discussion. This study showed that only 28% of 18–25
year olds achieved adequate physical activity levels as recommended by national guidelines, lower than reported for 2000 in England (58% of men and 32% of women amongst 16–24
]. PA levels here decreased with age and the time spent on computers/game consoles, whether for work/study or pleasure, increased gradually within this age group (12% to 20%).
In this study, positive attitudes (PA easy to do) was associated with being active and reduced TV watching. A recent review looking at descriptions by 11–16
year old girls of what it meant to ‘become a woman’
suggests that PA participation was ‘babyish’
]. This attitude may be contributing to the decreased levels of physical activity among 18–25
year old females in this study. There exists an attitude that changing diet behaviour was easier than exercising [24
] and that only a gym work out/participate in organised sports counted as ‘real’ exercise. The perception that they already undertook enough exercise and did not need to do more might stem from the attitude/belief that they might not become obese[25
]. The subjective norm variable did not predict any PA behaviours while young people will participate in activities for fun rather than to win or impress other people. PBC was associated with the final of the active exercise model but not with the sedentary behaviours. The focus groups revealed that many did not commence any new sport after moving to university/job or having children, in spite of being active at school. This could be because PA is more ‘organised’ in schools and becomes an individual’s responsibility once they become independent.
Despite good intentions to do more exercise, young people were unable to translate these into actual behaviour. While employment status, positive attitudes with PBC explained 55% of the physical activity intention, translation of intention into behaviour was poor; intention itself only explained 5.7% of the active exercise behaviour, 3% of sedentary TV watching behaviour; was non-significant for sedentary computes/games behaviour (Additional file 6
: Table S6) and remained significant in only TV watching once other variables were considered.
Barriers for doing adequate amounts of exercise identified from the survey were lack choices of activities and disability. However, focus groups identified specific issues to this age group. Although competitive sports and winning was identified as a motivator in the survey, particularly for men, it was seen as a major discouragement for many in the (female dominated) focus group discussions. Inadequacy and low self-esteem regarding body image made going to a gym or swimming pool, with the opposite sex, a barrier for females, mainly single mums. Studies have shown that those with low competence and self esteem do not generally engage in physical activity [12
]. Hence, improved facilities and activities focussed on single sex could motivate young women of this age group to participate more in physical activity.
Young people, although aware of the consequences, had no concerns about their future health. Obesity and other morbidities, are delayed consequences of a sedentary lifestyle[26
] and as such there is no ‘fear factor’
to encourage young people to change their behaviour. Concern for future health, depicted in many of these ‘empty’
health messages, seemed irrelevant to these young people and hence not the necessary concepts to motivate them to be more active.
Several studies in the past have assessed PA based on behavioural theories and found similar results although the strength of the relationships varied across studies [13
]. The main strength of the present study is that it captures a vulnerable age group (18–25
year olds) using a wide sample including not only students but also those who worked and those not in education, employment or training. This study also explained the in-depth meaning of the constructs through dynamic and interactive focus group discussions, providing a better understanding of elements relevant for young people.
However, there are several limitations that need to be acknowledged while interpreting the results. Data was collected using a self reported questionnaire with no objective measures of PA behaviour and hence a subject could over/underestimate their behaviour. Although the data could represent typical Caucasian young people undergoing similar transition, this data collection was restricted to a particular part of Scotland and thus will be limited when extrapolated to young people from other cultures especially with respect to the facilitators and barriers. Although efforts were made to recruit young people from the community, either working full time or Not in Employment, Education or in Training (NEET) for both quantitative and qualitative components of the study, this sample was over represented by students and the interpretation of the results should take this into consideration. In addition, for both quantitative and qualitative aspects, recruitment of young people at university/college was only possible through the institutions since direct access to students was not permitted. Major employers denied direct access to young people in work places due to time constraints and data protection issues. Consequently, only a random sample from the community was possible in order to capture those at work. This highlights the recruitment issues in this age group another potential limitation in generalising the results to those who work. It was impossible to calculate the response rate for the questionnaire survey in this study due to the institutional approach and subsequent lack of denominator. Consequently despite the large sample size, this survey only captured approximately 4% of the 18–25
year olds in the Grampian region, as estimated from the census data. For the qualitative study, recruitment was also a major restriction despite diligent attempts. While sufficient for this methodology, only 26 people participated in the qualitative study.
Interventions to improve physical activity in this age group might be successful in some targeted motivated populations [30
]. However, replicating these interventions at community level is unlikely to succeed as only a fraction of young people will participate and among those, few will lose weight. It is crucial to address barriers specific to young people and so build on factors motivating them to participate in interventions to improve and sustain their PA levels. For any intervention to be effective, the initial step would be to engage young people to participate and take ownership. Consequently, the traditional health promotion messages deemed ‘empty’ and ‘irrelevant’ by these young people need to be translated or tailored to be more attractive for recruiting and retaining them. Factors pivotal in sustaining such an interest in young people are ‘enjoyment’, 'appearance' and ‘feeling good’. Interventions incorporating these elements are more likely to encourage them to be involved in programmes initiated to bring about behavioural change to improve physical activity. However in the current obesogenic environment, individual responsibility can only be successful along with better provision to healthy lifestyle options [31
]. This suggests government, private and voluntary sectors work together to change the societal and environmental factors, whilst supporting individuals who want to make healthy choices[8
]. Future research should involve young people to identify these intervention components.