Understanding the walking behaviour of older adults in walking groups.
Background: Older adults are one of the least active groups within the population. Despite well documented health benefits of being physically active, older adults in the main are not sufficiently active to enjoy such health benefits. Walking is the most popular form of physical activity (PA) for older adults, and is the most promising form of PA to reduce inactivity. Group based walking is also known to be popular with older adults because it offers enhanced social opportunities. Understanding why older adults start and especially continue to walk in groups is important to effectively promote walking in this age group. Paths for All (PfA) is a Scottish charity that champions walking, and was the practice partner for this thesis. Overall the three studies in this thesis aimed to identify the individual, social and environmental factors that are linked to the initiation and continuation of older adult group walking. Methods and results per study: Study one: a qualitative systematic review was conducted to identify individual, social and environmental factors linked to the initiation and continuation of older adults involved in group walking. From the 14 studies included in the qualitative systematic review, the review found that group walking is globally popular among older adults within their 60s to 80s, in groups as far afield as Asia, America and Europe. The review also identified 10 themes and 63 sub-themes. It is evident that multiple factors influence both initiation and continuation, and these are often interlinked, with shared features such as friendliness, safety and enjoyment. Both individual and social factors appear to be more influential than environmental factors during both phases. Both initiation and continuation had themes that were phase specific, but shared some themes and sub-themes such as enjoyment of walking, keeping fit, managing health conditions, self-efficacy, social support from fellow walkers plus fun and laughter. There were no shared environmental sub-themes. Further, although individual and social factors were present in both phases, the quality of these factors appears enhanced over time e.g., enhancement in self-efficacy and social connectedness. The review also identified that the factors related to the initiation and continuation of walking appear to be perceived by older adults as beneficial to physical, mental and social health. Given the importance of both individual and social factors, the subsequent studies considered each of these in detail. Study two: a quantitative study informed by self-determination theory called WE:ROAM (N = 49) was undertaken to consider motivational changes in walking between two time points. Measurement for time point one was taken during the initiation phase of walking which was from week one to 6 months inclusive. Measurement for time point two was taken during the continuation phase, from 6 months onward. There was at least six months between the collection of data from time point one and time point two. This study identified that there were no significant or meaningful changes to the walking behaviour or motivational variables, contrary to the SDT pathway between phases. However, there were some relationships of significance between motivational variables at one time point, partially supporting the SDT pathway. Autonomy appears most strongly related to behavioural regulation, possibly suggesting that choice and control are important to motivation. In addition, relatedness was correlated with intrinsic motivation and vitality, suggesting that connection to others is related to vitality and quality of motivation. There were few relationships between the SDT variables and walking outcomes, which is also contrary to the SDT pathway. The lack of SDT pathway changes over time may be because the changes could have occurred prior to the first data collection. Although the findings of this study were not as expected, they do provide insight into the role of motivation on walking in groups. The findings indicate that autonomy satisfaction appears to be a particularly important need because it has the strongest relationships with behavioural regulations. It also seems that the level of relatedness satisfaction is strongly related to vitality and intrinsic motivation. Study three: a focus group qualitative study (N =39) called WE:ROASE was undertaken to explore social factors linked to the initiation of group walking, and if those social factors were the same or different at the continuation phase. The WE:ROASE study identified that social themes attached to the initiation and continuation phases were similar, and clustered into four key areas related to: experiencing social support; seeking and experiencing social connections; links with the community and neighbourhood; and experiencing the positive nature of the social environment. Although similar between phases, the quality and strength of the themes during the continuation phase increased. This study also identified four social context stages experienced by walkers between the initiation and continuation of group walking: initiation with phase 1 pre-joining/joining plus phase 2 settling in; and continuation with phase 3 bedding in plus phase 4 belonging and leading. Conclusions: Walking groups are globally popular among older adults from ages 60 to 80, and are perceived to be beneficial to physical, mental and social health. It is evident that multiple factors influence both initiation and continuation of older adult group walking in line with the ecological framework, and these are often interlinked. Factors at the initiation and continuation phases of group walking are phase specific, but share some similarities. The strength and quality of these shared factors are enhanced or become more pronounced during the continuation phase. Individual and social factors appear to be more influential at both phases of group walking than environmental. Changes in motivational factors between the initiation and continuation of walking may happen within weeks rather than months of walking, but older adult walkers may join groups with adaptive motivational regulation, high need satisfaction and vitality.