Establishing a successful physical activity program to recruit and retain women

Sport Management Review 13 (2010) 269–282

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Establishing a successful physical activity program to recruit and retain women Clare Hanlon *, Tony Morris, Susan Nabbs Institute of Sport, Exercise and Active Living, Victoria University, PO Box 14428 MC, Melbourne, Victoria 8001, Australia

A R T I C L E I N F O

A B S T R A C T

Keywords: Recruit Retain Women Physical activity Program

Increasingly, health organisations and governing bodies in developed countries are paying serious attention to the problem of adult inactivity. Many of the programs designed to increase levels of activity, particularly amongst target populations, such as women, have not been systematically assessed for their effectiveness in recruiting women and helping them maintain activity levels. The purpose of this study was to determine what attracted and sustained women to participate in physical activity programs. Responses from a survey to sport and recreation program providers identified 64 successful programs in the state of Victoria, Australia. Eight of these programs were purposively selected for case study analysis. Data was collected from a focus group with women participants from each of these eight programs. Six core themes emerged from inductive content analysis of the focus groups. The most frequent participant responses related to the social aspects of the exercise environment. Women in the focus groups valued instructor professionalism and instructors’ technical knowledge, however, it was their awareness and sensitivity that participants appreciated most. This exploratory study is important because it reflects the voices of women talking about what made physical activity programs successful for them. The study raises critical questions that should be examined systematically through largescale survey research and field-based intervention studies, which in turn should stimulate program development to encourage women in physical activity. Crown Copyright ß 2009 Published by Elsevier Ltd on behalf of Sport Management Association of Australia and New Zealand. All rights reserved.

A large, accumulated body of research has demonstrated that participation in regular physical activity enhances functional and emotional health throughout the lifespan, and promotes longevity and wellbeing in older age (Grzywacz & Marks, 2001; Hartman-Stein & Potkanowicz, 2003). Despite the profusion of information about the benefits of exercise, and intensive public campaigns to promote physical activity, significant proportions of people are found to either lead sedentary lifestyles or to not engage in physical exercise at levels sufficient to achieve positive health outcomes (Armstrong & Bauman, 2000; Hamdorf & Starr, 2002). Throughout the Western world, this has been found to be a far greater problem amongst women (Armstrong & Bauman, 2000; Biddle & Mutrie, 2001; Hamdorf & Starr, 2002; Huang et al., 1998) and to have particularly negative implications for older people (Choi, 2000). Increasingly, health organisations and governing bodies in developed countries are paying serious attention to the problem of adult inactivity. Primary care and community organisations have developed a range of innovative programs that are designed to increase levels of activity, particularly amongst target populations, such as women and the elderly. Physical activity programs delivered throughout the State of Victoria, Australia include VicFit’s Walk and Talk, VicHealth’s Walking

* Corresponding author. E-mail addresses: [email protected] (C. Hanlon), [email protected] (T. Morris), [email protected] (S. Nabbs). 1441-3523/$ – see front matter . Crown Copyright ß 2009 Published by Elsevier Ltd on behalf of Sport Management Association of Australia and New Zealand. All rights reserved. doi:10.1016/j.smr.2009.10.003

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School Bus, and the privately owned Pram Walkers. Many of these programs have not been systematically assessed by governing bodies for their effectiveness in initiating and sustaining increased activity levels within adult populations. Indeed, there is a particular lack of data on successful participation programs for women, implemented at leisure facilities (Cahill, 2003). This study addresses the question of what makes a physical activity program for women successful. The study highlights what causes inactivity amongst women and how physical activity programs that are designed and delivered according to the understanding of women’s experiences can be successful for the organisation and fulfilling for the participants. The outcomes of this study will assist in the future delivery of organised physical activity programs to women. 1. Facilitators and barriers to adult program participation Consensus has long existed around three broad areas of influence on adult participation in activity programs (Bolla, Dawson, & Harrington, 1993; Crombie et al., 2004; Little, 2002; Little, Lloyd, & Kiewa, 2003; McCabe & Hawkins, 2004; O’Neil & Reid, 1991). These are practical or material influences, such as program cost and access; personal or psychological influences, such as health status, self-image, and motivation; and social influences, such as peer pressure and environment. In recent investigations, researchers have found the most common influences on participation in activity programs are practical concerns, followed by psychological issues (Crombie et al., 2004; McCabe & Hawkins, 2004). Researchers increasingly stress, however, that individual circumstance and need ultimately dictate the impact of these influences on exercise behaviour and participation (Burton, Oldenburg, Sallis, & Turrell, 2007; Newson & Kemps, 2007). 1.1. Women’s participation in physical activity The literature on facilitators and barriers to physical activity in adults suggests women respond to different exercise motivators and gain different rewards from program participation than men. Researchers have found that women tend to favour non-competitive physical activity (Cann, 1991; Little, 2002; Vertinsky, 1995). Women are more likely to walk for exercise than men (Australian Institute of Sport, 2007) and avoid strenuous activities or organised sports considered typically masculine domains (Chalip, Bray, & Logan, 1999; Funk, Ridinger, & Moorman, 2003). Women are motivated to exercise more by a desire to address health concerns, control weight, and improve physical appearance, but are less motivated by performance issues, such as improving strength (Kilpatrick, Herbert, & Bartholomew, 2005; Newson & Kemps, 2007). Women also assign greater importance than male participants to the social support aspects of program participation (Brown & Frankel, 1993; Dishman, 1994; Kaplan, Newsom, & McFarland, 2001; Kilpatrick et al., 2005; Modra & Black, 1999) and they experience different types of enjoyment from program activities (Heck & Kimiecik, 1993). On the other hand, some researchers downplay the significance of gender to adult activity patterns, arguing that the experience of increased physical fitness and associated wellbeing is an equally strong exercise motivator for both men and women (Chalip et al., 1999; Dishman, 1994; Newson & Kemps, 2007). In addition to gender and adult activity patterns, ageing has been linked to the types of physical activity performed (Little et al., 2003). 2. Impact of life stage The impact of age on physical activity sets parameters around the ways in which individuals access leisure resources. Whereas the term convenience, is a commonly cited practical facilitator of adult exercise, a person’s age and associated lifestyle has enormous bearing on what constitutes convenience in a program (Dishman, 1994; Resnick et al., 2005). Young and middle-aged women, with care responsibilities, frequently complain that a lack of time interferes with their ability to participate in leisure activities (Kowal & Fortier, 2007; Little et al., 2003; Thompson, 1990). For these time poor women, freedom from long-term commitment to a program is a key indicator of convenience and a facilitator of participation (Kane, 1990; Little, 2002; Little et al., 2003; Thompson, 1990). In contrast, women aged 65 and over, nominate regular scheduling (Resnick et al., 2005), accessibility (Newson & Kemps, 2007), and affordability as key program conveniences (Braithwaite, Griffin, Stephens, Murphy, & Marrow, 1998; Little et al., 2003; Modra & Black, 1999; Richter, Macera, Williams, & Koerber, 1993). Similarly, older women gain greater satisfaction from the social support elements of their leisure activities than younger women, reflecting the distinct lifestyle priority of maintaining social connectedness in later life (Brown & Frankel, 1993; O’Brien Cousins, 1995). Although there is increasing interest in the impact of age on physical activity patterns, the literature demonstrates a preoccupation with older adults. This, in part, reflects an awareness of the importance of leisure activity to successful ageing (Brown & Frankel, 1993). Some investigators have criticised this apparent research bias, arguing that activity patterns and attitudes established early in life have significant bearing on exercise behaviour in later years (Brown & Frankel, 1993). Habit, or the frequency of past participation, influences the activity patterns of both older women and men (Aarts, Paulussen, & Schaalma, 1997; Burton et al., 2007). Although the proportional dominance of females in older populations makes the findings of studies of older age women particularly relevant to an investigation of women’s physical activity needs, a broadening of the research focus to encompass all age groups and lifestyles will clearly enhance our understanding of the impact life phase has on exercise behaviour.

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3. Psychological influences Personality and psychological orientation have significant influence on adult activity patterns (Burton et al., 2007; Dishman, 1994; Resnick et al., 2005). Researchers have recorded correlations between participation and attitude (Braithwaite et al., 1998; Crombie et al., 2004; Ronda, Van Assema, & Brug, 2001), intent to exercise (Courneya, Plonikoff, Hotz, & Birkett, 2000), and confidence or self-efficacy with regard to performing activities (Moore & Blumenthal, 1998). Exercise self-efficacy, in particular, emerges as a key influence on women (Chang, Fang, & Yang, 2006; Conn, Minor, Mehr, & Burks, 2000; Little et al., 2003; Modra & Black, 1999). Low level of confidence and self-belief can discourage women from participating in activity programs (Dishman, 1994; Little et al., 2003; O’Brien Cousins, 1995), as can lack of exercise-specific knowledge (Newson & Kemps, 2007). Commonly, women prefer to have an established skill base before they embark on an activity (Bartram, 2001; Little, 2002; Resnick et al., 2005), and the non-attainment of high outcome expectations can reduce women’s desire to adhere to a program over the long term (Wilcox, Casto, & King, 2006). 4. Social influences According to Western research, most formal leisure or health-related programs attract healthy, independent, white, educated participants, indicating the significance of socioeconomic variables to exercise behaviour (Burton, Turrell, & Oldenburg, 2003; Giles-Corti & Donovan, 2002). In an Australian study of a Queensland-based adventure program for women, Little et al. (2003) found the majority of participants did not have dependent children and were in full-time employment. Similarly, in a Netherlands-based study, Freisling, Elmadfa, and Gall (2006) found a ‘‘manual labour’’ group of pregnant women were more than four times less likely to engage in structured physical activity than a ‘‘non-manual labour’’ group (p. 437). Indeed, women who fall into socially disadvantaged categories, such as single, older women, or women with limited resources and independence, face additional barriers to participation in community-based programs (Groupp, Hass, Fairweather, Ganger, & Attwood, 2005). Sharpe et al. (1997) noted a knowledge gap concerning the development of health-promotion programs for low income, rural, or minority older adults. They concluded that the small amount of data concerning socio-cultural influences on exercise behaviours is inconclusive. Whereas American investigators have reported distinct activity patterns amongst southern-based black American populations (Kalavar, Kolt, Giles, & Driver, 2004; Ronda et al., 2001), Australian researchers have found no significant difference between the participation patterns of urban- and rural-based populations (Chalip et al., 1999). Indeed, Australian researchers have emphasised the similarities in adult exercise patterns across western democratic societies and downplayed the influence of socio-cultural variables, such as ethnicity and location, on exercise behaviours (Newson & Kemps, 2007). 5. Knowledge Understanding the benefits of regular physical activity has a positive effect on adult exercise behaviour. Certainly, health concerns positively motivate older adults to increase their physical activity levels (Kolt, Driver, & Giles, 2004; Newson & Kemps, 2007). Nonetheless, based on their findings, researchers increasingly challenge the notion of heath benefit knowledge, as a significant exercise motivator (Braithwaite et al., 1998; Heck & Kimiecik, 1993; Marshall et al., 2004). The provision of information on the benefits of exercise has not in itself positively influenced younger adults (Dishman, 1994; Jones, Sinclair, Rhodes, & Courneya, 2004) or retirees (Resnick et al., 2005) to participate in activity programs. Indeed, misconceptions about the negative impact of exercise on health in older age act as a disincentive to participation in some programs (Richter et al., 1993). Yet, program endorsements that facilitate participation have a positive effect when a trusted source, such as a local General Practitioner or peer, delivers them by word of mouth (Braithwaite et al., 1998; Cohen-Mansfield, Marx, Biddison, & Guralnik, 2004; Conn, Burks, Minor, & Mehr, 2003; Groupp et al., 2005). 6. Characteristics of successful programs An argument has been made (Little, 2002) that program providers and policy makers can play a key role in reducing impediments to leisure participation amongst adult populations. Addressing practical barriers around program cost and accessibility has proven beneficial in recruiting and keeping older adults in activity programs (Cohen-Mansfield et al., 2004; Crombie et al., 2004; Modra & Black, 1999). Providing commitment-free membership to women with care responsibilities has also proved a successful recruitment strategy. Indeed, the benefits to be gained from tailoring programs to suit the practical needs of individuals and population sub-groups is increasingly seen to underpin successful recruitment into activity programs (Cohen-Mansfield et al., 2004). Addressing psychological and social barriers is clearly a greater challenge for service providers. Researchers have traditionally focussed interventions on changing personal attitude, intent, and self-efficacy (Chogahara, Cousins, & Wankel, 1998). Health and fitness professionals have typically attempted to motivate people to exercise by educating them on the health risks and benefits associated with various levels of physical activity (Heck & Kimiecik, 1993; Wankel, 1985). Yet researchers have increasingly argued that people implementing programs should adopt motivational strategies with a

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recreational focus, emphasising the enjoyment and quality of experience that program participation brings, rather than the health outcomes (Armitage & Connor, 2001; Blue, Wilbur, & Marston-Scott, 2001; Courneya & McAuley, 1995; Dishman, 1994; Lowe, Eves, & Carroll, 2002; Rhodes & Courneya, 2003; Sharpley & Yardley, 1998; Wankel & Berger, 1990). There is also growing consensus that activity programs for women should aim to increase participant confidence and selfworth (Little et al., 2003; McCabe & Hawkins, 2004; Resnick et al., 2005). The establishment of non-competitive environments (Bialeschki, 1999), in which women feel ‘‘safe and supported’’, is considered a key response to this challenge (Little et al., 2003, p. 60), as is assisting individuals to enter programs that are appropriate to their needs and abilities (Chalip et al., 1999). The provision of women-only programs has proven particularly successful in developing exercise self-efficacy (Little et al., 2003). Researchers have found that trainer demeanour had a significant influence on participant perceptions and experiences (Cohen-Mansfield et al., 2004; Jones et al., 2004). Middle-aged, independent women have been found to respond well to group leaders who demonstrate a higher physical skill level than themselves (Little et al., 2003), whereas older women prefer trainers who are similar in age, attitude, and ability (Black & Scott, 1996; Cohen-Mansfield et al., 2004; Modra & Black, 1999; Resnick et al., 2005; Richter et al., 1993). On a broader level, Australian researchers have argued the social construction of female health and leisure needs to increase the priority and appeal of sustainable physical activity for women (Little et al., 2003). To this end, researchers have proposed that the impact of unrealistic body image expectations on women must be addressed. Ultimately, women need encouragement to pursue the benefits of general good health and improved fitness, rather than emulating certain body ‘‘ideals’’, if they are to achieve positive and lasting outcomes from their participation in activity programs (Kilpatrick et al., 2005, p. 93). The literature has highlighted the practical or material, psychological, and social aspects associated with encouraging women to be physically active. In the state of Victoria, Australia, primary care and community organisations have developed programs targeted at increasing levels of physical activity for women. However, there is a lack of data on what factors facilitate recruitment and retention of women in physical activity programs. It is, therefore, the purpose of this research to examine what makes physical activity programs for women successful in recruiting and retaining participants. To explore this issue, we conducted focus groups with participants in successful community sport and active recreation programs throughout Victoria, Australia. For the purpose of this investigation, successful programs were defined as community sport or active recreation programs for women that retained and encouraged ongoing participation and had been running for more than 3 years. 7. Method To achieve the purpose of the study, it was necessary to identify successful physical activity programs for women in Victoria, Australia. We did this by distributing surveys to Local Council and Regional Sport Assembly (RSA) managers. Regional Sports Assemblies are not-for-profit, community-based organisations, which have been established by the Victorian state government to support the development of sport and recreation clubs in regional Victoria. From the responses given by local council and RSA managers, to determine what stimulated women to participate in such programs, we conducted focus groups with women from eight programs purposively selected because of their success in recruiting and retaining women over a minimum of 3 years. 7.1. Identification of successful programs We surveyed 68 Local Council and eight RSA managers to identify successful physical activity programs for women, implemented by community sport and active recreation organisations throughout Victoria, Australia. Success was determined by high levels of recruitment and retention of participants for more than 3 years. We received 37 surveys from managers and assembly leaders (48%), 22 from the regional area and 15 from the metropolitan area. We discovered the low response rate was due to the lack of awareness by respondents of what community sport or active recreation programs targeted for women existed in the community. Surveys were returned unanswered, with an attached letter, emails were sent by respondents or we made follow-up phone calls that indicated the lack of awareness. The managers who did respond identified 47 successful programs. The eligible programs included gentle exercise, strength and conditioning, pram walking, general walking, group fitness, mother and child aqua-based aerobics, dance, yoga, tai chi, and swimming. 7.2. Focus group study of physical activity programs for women 7.2.1. Sample From the 47 programs we identified in the survey of managers, we purposively selected eight programs for case study analysis (Yin, 2003). To ensure sample variety, we used a range of criteria to select the programs. These included representation of metropolitan and regional communities; different organisational types, including private (e.g., gymnasium or tennis coaching, local leisure centre), public (e.g., local council, neighbourhood house), and not-for-profit (e.g., community group) organisations; different activities; and varied life stages of women, comprising full-time and part-time workers (18– 50 years), at home mothers (18–50), and older adults (50+). Details of the programs included in the study are displayed in Table 1.

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Table 1 Independently identified successful programs. Location

Organisational type

Program activity

Life stage

Metropolitan Metropolitan Metropolitan Metropolitan

Public Private Public Not-for-profit

Dance Yoga Pram walking Walking

Workers and older adults (40+) Workers (18+) At home mothers (18+) Older adults (50+)

Regional Regional

Private Public

Older adults (50+) At home mothers (18–45)

Regional Regional

Not-for-profit Private

Strength and conditioning Mum/bubs varied activities, e.g., group fitness, swimming Group fitness Aqua aerobics

Workers and at home mothers (18+) Workers and older adults (45+)

Once a program was selected for the focus group stage, we asked the program manager to assist in recruitment of participants for the focus group. Upon their agreement, we sent 20 requested information packs to the program managers who gave the packs to all program participants. Each pack included a Letter of Invitation and an Information to Participants Sheet. Once the program participants had read the information and volunteered to be part of a focus group, they phoned the researchers to register. We included the first 10 respondents from each program in the focus group from that program. 7.2.2. Data collection To determine what factors the research participants perceived attracted and sustained their participation in the program they attended, we conducted one focus group for each of the eight selected programs. The eight focus groups ranged in size from 4 to 10 participants, with a total of 60 participants overall. The total number of participants in each focus group depended on their availability. The purpose of the focus groups was to gain a greater understanding about what attracted women to participate in physical activity programs and what sustained their participation. Sample questions included: ‘‘what encouraged you to join the program?’’, ‘‘what do you like about the program?’’, and ‘‘what can make it difficult to attend the program?’’. We conducted focus groups in the facility where the program was presented or at nearby facilities after activity sessions. For example, some sessions took place in the tea room or social area of a facility. Each session lasted approximately one and a half hours. We video- and audio-taped the focus groups, then transcribed the audio-tape. The video recording was used to help transcription of the audio recordings when more than one person was talking. To ensure participant contribution remained confidential during the data collection, transcription, and data analysis, we assigned pseudonyms to participants. To assist with confidentiality of information amongst participants, prior to each focus group, an information letter was sent to participants outlining the importance of confidentiality of the discussion in the focus group. The focus group convenor reiterated this prior to the commencement of the session, and a consent form was signed by each participant prior to the conduct of the focus group that included the need for confidentiality. 7.2.3. Data analysis To determine the main themes emphasised by women participants, we first coded the focus group material using NVIVO. This enabled us to use a process of constant comparison to determine the main themes that emerged from the discussion in the focus groups. We developed this analysis progressively, as focus groups were conducted. Miles and Huberman (1994) defined such codes as tags or labels for assigning meaning to the descriptive or inferential information compiled during research. Through the coding process, we reduced the data and directed the analysis toward trends, themes, and patterns that assisted in identifying what participants perceived to make their programs successful in the attraction and retention of women. 8. Results In this section, we present the results of the inductive content analysis performed on the data that was generated by the focus group sessions with participants in the eight targeted physical activity programs for women. The audio recordings of the focus groups were transcribed into more than 500 pages of 12-point, double-spaced text. We classified these verbatim transcriptions into 79 raw data themes. While there were multiple themes that emerged from the raw data, the information presented in this article focuses on the responses addressing the women’s attraction to attend the programs and their sustained participation. The results of the inductive content analysis are presented in Table 2. Here we report on the six core themes that emerged each with a range of subthemes, namely factors affecting participants’ involvement; participants’ influence on program delivery; instructors’ influence on participant involvement; environmental factors affecting participant involvement; organisational factors affecting program involvement; and social influences on the exercise environment. We describe the subthemes and the most noteworthy raw data themes in each core theme. We include quotations to illustrate themes, using pseudonyms to integrate these into this section.

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8.1. Personal factors affecting participants’ program involvement The first core theme includes those issues of a personal nature that participants reported either encouraged them to participate or inhibited their involvement. There were six subthemes. Five subthemes referred to personal factors that encouraged participation and one subtheme concerned personal factors that inhibited their involvement. In the first subtheme, participants noted a number of psychological benefits of involvement. Enjoyment and reduced depression and anxiety were frequently mentioned, but the most common psychological benefit was that the program provided personal time for the individual. One respondent encapsulated this view: Doing something for yourself. Working and with kids you do everything for everybody else, but Thursday’s my walking day and that’s for me. The one thing I do every week that’s just for me (Robyn). Focus group members also claimed that health benefits motivated them to take part in the program, making this the second subtheme. Relaxation and improved sleep, along with weight loss or maintenance were the most prominent health benefits participants named in this subtheme. Sarah noted: I benefit from the gym from a weight point of view and when I come to the gym I feel more toned and I feel better in my clothes. I don’t know, I’m not a confident person and it just gives me that little bit more confidence.

Table 2 Inductive content analysis of focus groups for female participants. Raw data themes

Subthemes

Core themes

Provides personal time (16) Increased confidence (9) Enjoyment (12) Motivation to complete other tasks/exercise (6) Reduced depression and anxiety (11) Improved sleep (6) Increased relaxation (8) Weight loss/maintenance (13) Increased flexibility (10) Increased cardio-vascular endurance (20) Increased strength (5) Improved posture (3) Learn new skills (5) Gain knowledge about exercise and weight (5) Learn about general health issues (7) No special equipment required (5) No pressure to attend (5) Low in cost (10) Injury or illness (8) Lack of connection with the activity (1) Return to work or part-time work commitments (6) Caring duties of children or partner (4)

Psychological benefits for the participant

Personal factors affecting participants’ involvement

Have input on the type of activities included in the program (10) Ability to determine the length and pace of the activity (16) Non-judgmental atmosphere (13) Non-competitive (5) Members encourage and motivate each other to participate (22) Members contact each other if they are absent (9) Members assist each other to get to the program (7) Members look after each other’s children (2) Instructor is caring (4) The instructor listens (4) Instructor is welcoming and friendly (15) Instructor is qualified and knowledgeable (12) Instructor sets activities appropriate to ability level (15) Instructor provides alternate activities (12) Instructor allows participant input (11) Instructor provides resources/additional information (3) Instructor provides rewards (8)

Health benefits for the participant

Physical fitness benefits for the participant

Education benefits for the participant

Low demands for the participant to be involved in the program Personal inhibitors to program involvement

Participants program ownership

Participants’ influence on program delivery

Participant provides a supportive exercise environment

Interpersonal skills of instructor

Professional skills of instructor

Instructor influence on participant involvement

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Table 2 (Continued ) Raw data themes

Subthemes

Core themes

Poor facilities (5) Weather (6) Lack of transport (4) Facility overuse (5) Lack of child care provided by facility (5) Wide and smooth walk paths (9) Scenic walk trails (4) Feeling of safety (2) Appropriate car parking (5) Clean and appropriate change rooms (2) Comfortable exercise areas (4) Variety of indoor exercise areas (2)

Environmental inhibitors to program involvement

Environmental factors affecting participant involvement

Advertising in local paper (14) Adverts place on radio (1) Flyers about program place in community organisations (13) Articles about program in newspaper (3) Brochures placed in letter box (5) Provide childcare (3) Provide equipment for children while mother exercises (2) Provision of guest speakers (2) Provision of a volunteer leader or paid coordinator (12) Schedule time appropriate to groups (5) Target activities suitable for group (1) Flexibility in programming (5) Provide a variety of activities suitable for the individual’s ability (25) Participants able to suggest improvements (2) Organisation responds to participant concerns or needs (9) Payment options (4) Utilise facilities of other organisations (6) Decrease feelings of isolation (15) Opportunity to meet people (12) Develop new networks (3) Welcoming atmosphere (18) Opportunity to chat with others (35) Focus event at end of session (13) Additional social outings outside of exercise time (12) Special events for significant days (3) Friends encourage me to participate (18) Informed by co-participants from other programs (7) Referral by community nurse, physiotherapist, doctor (15)

Environmental enhancers to program involvement

Organisations methods for recruitment of participants

Organisational factors affecting program involvement

Organisation provides a supportive environment

Organisational factors affecting program implementation and delivery

Social connectedness

Social influences on the exercise environment

Social aspects of the exercise environment

Social factors influencing initial program involvement

Participants distinguished physical fitness benefits from general health, as a separate subtheme. By far the biggest emphasis here was on cardio-vascular endurance, although the focus group members also mentioned flexibility, strength, and posture. Women involved in the study also referred to educational benefits of participating in the physical activity program. Some claimed they had learned new physical skills, whereas the most common benefit reported by the respondents in this subtheme was that they had learnt about health, weight, and exercise. We joined the walking group first and then we just decided while we are walking we may as well learn how to eat healthily as well. And another spin off is the Women’s Health Nights that we have had, looking at different things like menopause (Linda). As opposed to physical and psychological benefits, one subtheme related to factors that affected participation was that participants considered that the activity placed few demands on them. Most activities were perceived to involve little cost and no special equipment. In addition, participants reported that there was no pressure to attend. Tania highlighted this point by stating: I think what makes it a good exercise program is because there is no pressure to actually walk. You don’t feel like, ‘‘oh no, I haven’t done my exercise’’; you just go when you can and maintain it as you can. Focus group members did mention some issues that acted as personal inhibitors to their involvement in their physical activity program. In this final subtheme in the personal factors affecting participation core theme, they included illness and injury, work commitments, and child care duties as factors that made it more difficult for them to take part in the activity.

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8.2. Participants’ influence on program delivery The second core theme displayed in Table 2 refers to the participants’ influence on program delivery. The subthemes in this core theme relate to ways in which the women involved in the activity helped to create a positive and supportive environment in which to be physically active. This core theme included two subthemes, one related to the sense of ownership participants experienced for the program and the other concerned with perceptions that the program provided a supportive environment. The opportunity to determine the types, length, and pace of the physical activity in the program were strong subthemes that participants reported gave them a feeling of program ownership. As one respondent noted: When we first meet, we get together and they mention all the activities we can participate in. Then everyone writes down the one that they would like to do. From that a program is made up, so it’s catered to individuals and the group (Katie). The most widely cited aspect of the supportive exercise environment subtheme was the efforts made by women in the program to motivate and encourage each other. Many participants also reported the creation of a non-judgemental atmosphere as a positive aspect of the supportive physical activity environment. Statements from two respondents highlight this point. Josephine commented: When I started I found people in the group very, very encouraging, that’s what really convinced me to stay. They would say, oh don’t worry, just keep going. Now this is what I am saying to other people. Pam stated: I feel really comfortable to participate in something that I’m not 100% confident in because you know you are not going to be judged or criticised. It is a really comfortable and nurturing environment. 8.3. Instructor influence on participant involvement The third core theme that we identified from the focus group transcripts referred to the instructor’s influence on participant involvement. It included two subthemes. The interpersonal skills of the instructor represented a subtheme that related to the caring manner of the instructor and their capacity to listen to participants. Most often participants spoke positively about the welcoming and friendly style presented by the instructor. Our instructor is very, very caring. She moves around to everyone of us and has a chat. She knows what is going on in our lives and asks us if we such-and-such last week. She is a motivator as well. She gets more excited about our weight loss than we do (Tania). Parallel to good interpersonal skills, the women in the physical activity programs also praised the professional skills of instructors, which encouraged participants to keep participating. Amongst these professional skills, which represented the second subtheme, instructors who set activities that were well suited to the ability level of the participants were favoured, and when the instructors set alternate activities and encouraged participants to contribute to the choice of activities and levels, the participants in the focus groups reported that they further promoted participation. As noted by Joan: ‘‘She’s nice, she treats us as individuals and we’ve got different aches and pains, so she lets us choose what we can do and sets activities for each of us’’. In general, participants reported that they were encouraged to participate when they considered that their instructors were well qualified and knowledgeable about their role. 8.4. Environmental factors affecting participant involvement The fourth core theme, environmental factors affecting participant involvement, includes environmental issues participants’ identified as inhibitors and/or enhancers of program involvement. There were two subthemes. In the first subtheme, women identified a lack of child care provision by a facility, unsuitable weather, poor facilities and facility overuse as inhibiting factors. The second subtheme included environmental factors that encouraged continued involvement in the physical activity program. Women involved in programs that were conducted in the outdoors stated that the scenic nature of the exercise environment was very important and that the paths used for exercising should be smooth, wide, and safe. Sarah encapsulated this view by stating: Our original walks were on pavers and they were terrible. You had to walk single file. So that was sort of how we got to trying to choose the right paths, concrete bike paths, with enough room to have two prams together so you can chat, because single file is dull. In programs that were conducted in a facility, women noted that clean and comfortable exercise areas and change rooms encouraged continued participation. Thus, participants did not express an overall preference for outdoor or indoor activities. They enjoyed activities in both types of environments, but focused on different issues for outdoor activities, e.g., safety and the scenic nature of the environment, and indoor activities, e.g., cleanliness and comfort.

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8.5. Organisational factors affecting program involvement The fifth core theme identified from the focus group raw data relates to organisational factors affecting program involvement. This core theme refers to strategies and processes employed by organisations conducting physical activity programs to recruit and retain women. It included three subthemes. The method used by an organisation to recruit participants is the first subtheme. The most common methods used by organisations that were identified by women, were seeing an advertisement in the local paper or reading a flyer about the program in another community organisation. I was new to town and I found out about the centre in the paper through an advertisement. They were advertising general membership, so I came down and got information and chose the programs I wanted to do (Josephine). The second subtheme relates to the ability of the organisation to provide a supportive environment. This included the provision of childcare or equipment for children to play with while the women exercised. For example, Marie stated: I just come in after I drop the kids at school and put the baby in the cre`che and do every 9.15 class. I don’t care what it is. I just want an hour workout in the morning, I feel so much better for it. The third subtheme relates to factors affecting program implementation and delivery. Women reported that the ability of the organisation to deliver a program that included a variety of exercises suitable for each individual’s ability level was the most important factor affecting participation. Also important was the organisation’s willingness to provide leadership and program support through the provision of a paid or volunteer coordinator. Additional programming issues included appropriate scheduling, flexibility in programming, and the need for the organisation to respond to participant concerns or issues. I was talking to the instructor about people who go on the walks and then they have to go back to work and they are not meeting the mums anymore and they’re not getting the exercise. We suggested some night walks or early in the morning or on the weekend. So we have had one or two on the weekends and the Dads can come too (Linda). 8.6. Social influences on the exercise environment The final core theme that we identified from the focus group data was the social influence on the exercise environment. This core theme focused on the social nature of women and how this influences program recruitment and implementation practices. There were three subthemes. The first subtheme was centred on the women’s use of the physical activity program for social connectedness within their community. Women, especially those new to an area or recent mothers, proposed that one of the initial reasons for joining an exercise program was to get them out of the home. They discussed a need to meet new people and develop new networks. Two examples of respondents’ statements reinforce the need for social connectedness. Lesley reported: I do it because I just moved here from New Zealand and I knew not a soul and we lived just up the road and I saw this as a way to meet a cross section of people. It wasn’t the exercise it was more a social thing. Pam stated: After having a baby, you think ‘‘oh my god I need to do some exercise’’. But it was also the social component of it too, like I need to get out of the house and being a career person and then not really knowing a lot of people in town, I thought it was a good way to get out and mix. Most importantly focus group participants reported that the program decreased their feelings of isolation. The social nature of the program environment was very important for continued participation and this was the second subtheme. The women who participated in the focus groups spoke of the opportunity to chat with others during the exercise period and at the focus event at the end as very important. A welcoming atmosphere engendered by fellow participants encouraged continued participation. I joined mainly for the social activity, not just the exercise. It’s a group thing, we do a walk and we enjoy walking and talking. Jo’s children are the same age as mine at school and so we enjoy talking about them as well (Molly). In addition to the social aspect during the exercise program, women mentioned the opportunity to socialise outside the exercise environment with participants at special events as another reason to continue participation. The focus group participants often learnt about a program through social means, such as a referral from a health professional, a co-participant from another program informing them, or friends encouraging them to participate. These social factors influencing initial program involvement were incorporated in the third subtheme. I had a hip replacement and needed to exercise. So I scouted around, made enquires with ladies from different groups and I heard about the hospital program and then I heard about this program (Margaret).

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9. Discussion The purpose of this study was to examine what participants considered makes physical activity programs for women successful in terms of recruitment and retention. To explore this issue, we conducted focus groups with participants in eight successful community sport and active recreation programs throughout metropolitan and regional Victoria, Australia. Six core themes emerged from inductive content analysis of the focus groups. These related to personal factors affecting participants’ involvement; participants’ influence on program delivery; instructors’ influence on participant involvement; environmental factors affecting participant involvement; organisational factors affecting program involvement; and social influences on the exercise environment. The content of these core themes indicates that women have specific needs and demonstrate distinct behaviours with regard to participation in community sport and active recreation programs. Nonetheless, the focus group members reported being attracted to participate in their programs by factors that were similar to those reported in research with adolescents and older adults of both genders. These factors included physical and psychological health, fitness, and learning and developing skills (e.g., Gill, Gross, & Huddleston, 1983; Morris, Clayton, Power, & Han, 1995). The participants in the present study placed particular emphasis on several factors not prominent in previous research. These were having personal time and doing an activity that was not demanding in terms of cost or equipment. Notably, factors that participants reported inhibited their involvement were not related to the activities, but were external influences, such as illness, work commitments, and child care duties. In these ways, it appears that gender and life stage of women shaped their involvement in physical activity programs. The emphasis placed by women on the need to accommodate individual requirements and abilities wherever possible is a particularly telling result. Discussion in the focus groups also emphasised that their ability to influence the physical activity programs encouraged women to participate. Two ways in which this was particularly evident were through women’s sense of ownership in the program and their efforts to provide a supportive environment for physical activity. The benefits of choice and influence over behaviour represent a central determinant of self-determined action, which enhances intrinsic motivation, according to Deci and Ryan (1985). Also related to self-determination was the third core theme that participants identified, namely instructors’ influence. Instructors in successful programs displayed the combination of a caring manner and the ability to listen to participants. Through this approach instructors provided opportunities for participants to choose the types and levels of activities in their program. This was generally acknowledged by participants to promote their continued participation in these successful programs. It is likely that these instructor behaviours also enhanced perceived competence of participants, which is proposed by Deci and Ryan (1985) to be the other key to promoting intrinsic motivation. The research conducted by Deci and Ryan, which is now widely replicated, indicated that people who are intrinsically motivated persist longer and make more effort in activities, as well as gaining more satisfaction and enjoyment from their participation. The most frequent participant responses related to the core theme associated with the social aspects of the exercise environment. Specifically, participants in the current research emphasised the importance to program success of providing women with an opportunity to socialise before, during, or after a physical activity program. Women in the focus groups reported that one reason they joined their physical activity program was that friends told them about the opportunities it offered for exercising in a social and supportive environment. Women often maintained the social network created through their program once they were established in it. These findings support the view that women emphasise the importance of social support aspects of program participation (Brown & Frankel, 1993; Dishman, 1994; Kaplan et al., 2001; Kilpatrick et al., 2005; Modra & Black, 1999). Given the diversity in age amongst the sample, results of this research suggest that providing an opportunity for women to socialise is a vital contributor towards physical activity program success, regardless of the life stage of women. Another core theme that emerged from participant responses in the focus groups was organisational factors affecting program implementation and delivery. In particular, the women who took part in focus groups emphasised the importance of organisations being sensitive to the specific needs of women and operating in a manner that was sufficiently flexible to adjust to those needs. This included the provision of child care facilities and play areas for children, flexible program schedules, and the inclusion of a variety of activities to suit program participants’ interests and skill levels. We found that research participants recognised the value of tailoring programs to suit women with a range of individual needs. This is consistent with other research that has developed successful physical activity programs for women for example, Berger, Darby, Carels, Owen, and Grove (2009). The final core theme that emerged from the focus groups related to positive and negative aspects of the environment. Women enjoyed doing physical activity in outdoor and indoor environments, but identified different aspects of those two types of environment to be critical to their satisfaction. For outdoor activities, the focus was on scenic and safe environments, whereas participation was promoted in indoor facilities that had clean and comfortable exercise areas and changing rooms. Poor and overused facilities inhibited participation. These findings support the general view that practical or material influences contribute to adult participation in physical activity (Crombie et al., 2004; McCabe & Hawkins, 2004). Results of this research indicate that identifying the positive aspects of the exercise environment is an important contributor towards physical program success, regardless of the age of women.

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9.1. Methodological issues and future research directions The conclusions derived from the present research should be viewed with caution because they represent the perceptions of a relatively small sample of women selected purposively to represent physical activity programs that had demonstrated success in terms of recruitment and retention for over 3 years. The research reflects the views of women from a particular location, only one state in Australia, and a specific time. Replication of this research in different geographical and socioeconomic contexts should clarify whether the key factors associated with successful physical activity programs in this study can be generalised. It should be noted, however, that the present study did involve women from a variety of metropolitan and regional areas, who represented a breadth of demographic characteristics. Further light could be shed on the factors that promote success in physical activity programs by contrasting such designated successful programs with programs identified as less successful. This focus group study provided rich information about the experiences of the women who participated, but it also raises questions that will only be answered by the use of a range of research methods. Participants in the present study proposed that a number of factors contributed to the success of the physical activity programs of which they were members. Further research should be conducted to determine whether some of these factors are necessary for program success, whereas others may enhance programs, but are not essential. Ideally, we would recommend that all the positive factors should be strived for and the negative ones avoided. Where resources are limited, however, priorities must be identified. Thus, for example, will a listening and responsive instructor facilitate a successful program, even if the physical environment is not ideal? An alternative approach may be to explore the relative influence of different factors. Large-scale survey research amongst women who participate in physical activity programs is an approach that could be based on the information that emerged in the present study. The design of the present study did not permit examination of the interaction between factors that influence the success of physical activity programs. It is unlikely that the same set of factors will have the same impact in all contexts. For example, the key determinants of physical activity program success amongst women in regional and rural communities might differ from the most important elements of successful programs offered in inner city environments. Research that points to differences in emphasis related to contextual variables will inform program developers about key factors in those different contexts. Indeed, demonstration of the strength of influence of various factors would be of great value to program managers and providers. These factors could guide program managers when they design, market, and deliver their activities for women. The issues raised in this section point to the value and the limitations of focus group research. The present study has raised questions that might be best addressed by large-scale survey research in which differences between personal or situational variables can be identified or by field experiments, where one or several variables are systematically manipulated and their impact on outcomes, such as recruitment and adherence, are monitored. 9.2. Implications for the management of physical activity programs for women Women are still underrepresented in organised physical activity in countries like Australia. Managers in organisations that provide physical activity for the community should seek ways to increase participation in physical activity by women across the lifespan. The results of the present study highlight the potential for women participants to provide a vital knowledge resource to management and assist in determining the specific elements of successful recruitment and retention strategies. For example, results from this study indicate that participants who contributed towards program delivery and improvement were more likely to take ownership in the program, which then contributed to those participants maintaining their involvement and other women wanting to become involved in programs. Thus, perhaps during social interaction time, program providers could identify the needs of the group for program improvement in order to further increase participant satisfaction with the program. For managers aiming to recruit participants, so physical activity programs for women develop and are sustained, participants’ positive experiences can be a strong marketing strategy. This was confirmed by the focus groups where women reported that they were attracted to physical activity programs by participants’ favourable descriptions of the program they attended. Another effective word-of-mouth recruitment source was trusted professionals, such as community nurses, physiotherapists, and doctors. Other researchers have also reported that program endorsements facilitate participation when delivered word of mouth by a trusted source, such as a peer or local general practitioner (Braithwaite et al., 1998; Cohen-Mansfield et al., 2004; Conn et al., 2003). These results highlight the importance of program providers creating relationships with local community organisations that attract women. Central to the message managers convey to these organisations should be testimonials of women who participate in programs, emphasising the program characteristics most valued by these women, such as the supportive group atmosphere, including opportunities to socialise, and the variety of activities appropriate for different participant levels and needs. Based on the results that emerged from the focus groups in the present study, we recommend that managers of physical activity programs for women should select instructors for such programs with a particular emphasis on listening skills and willingness to respond to clients’ needs. Although women in the focus groups valued instructor professionalism and technical knowledge, it was their awareness and sensitivity that participants appreciated most. In a recent qualitative study of reasons for termination of personal training, Timmermans and Morris (2009) found that clients frequently reported

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instructors’ lack of interpersonal skills and consideration of clients’ needs to be preeminent reasons for termination. If managers of physical activity programs flag their preference for instructors who have had formal interpersonal skills training, this could also influence the curriculum of organisations that train fitness professionals. A key factor over which managers have more direct control is the exercise environment. Participants in the focus groups stressed the importance of safe and scenic outdoor environments and clean, attractive indoor facilities to the success of physical activity programs for women. This factor appeared to link with women’s preference for programs to have a warm, welcoming atmosphere. It was also associated with the desire to socialise, because women emphasised wide paths outdoors, so they could interact while exercising and comfortable areas indoors where they could sit and talk. Managers should also note key organisational issues raised in relation to the successful physical activity programs. One characteristic that consistently emerged from the focus group discussions was the importance of organisations being supportive to the needs of women. Participants particularly praised the provision of child care facilities with safe and interesting activities for their children to do, while they exercised. Another kind of support was reflected in organisations that offered a variety of options for women with different interests and abilities, reflected flexibility in operation, such as by locating programs at times that suited women, and that appeared to be responsive to concerns that were raised. We recommend that managers pay particular attention to these issues, if they aim to provide physical activity programs for women that will attract participants and, importantly, that will retain the involvement of women in the long term. Developing strategies related to these recommendations will undoubtedly be challenging, as they make competing demands on resources. Of course, successful programs will attract resources and increasing physical activity amongst women should be a priority for the allocation of resources. 10. Conclusion In this study, we employed eight focus groups to examine the factors that women perceived to enhance the success of physical activity programs. We identified six core themes, including factors that affected involvement, participants’ influence on program delivery, instructors’ influence on participants’ involvement, social factors, environmental influences, and organisational factors affecting success. 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