Barriers to and Facilitators of Adherence to Prescribed Home Exercise in Older Adults at Risk of Falling in Singapore: A Qualitative Study

in Journal of Aging and Physical Activity

Click name to view affiliation

Bernadine TengSchool of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
Health and Social Sciences cluster, Singapore Institute of Technology, Dover, Singapore

Search for other papers by Bernadine Teng in
Current site
Google Scholar
PubMed
Close
https://orcid.org/0000-0002-4908-3682*
,
Ingrid C.M. RosbergenSchool of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
Conjoint Research Fellow Physiotherapy, STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), University of Queensland and Metro North Hospital and Health Service, Herston, QLD, Australia

Search for other papers by Ingrid C.M. Rosbergen in
Current site
Google Scholar
PubMed
Close
https://orcid.org/0000-0002-3576-2721
,
Sjaan R. GomersallSchool of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia

Search for other papers by Sjaan R. Gomersall in
Current site
Google Scholar
PubMed
Close
https://orcid.org/0000-0001-6808-0180
,
Anna HattonSchool of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia

Search for other papers by Anna Hatton in
Current site
Google Scholar
PubMed
Close
https://orcid.org/0000-0002-5612-469X
, and
Sandra G. BrauerSchool of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia

Search for other papers by Sandra G. Brauer in
Current site
Google Scholar
PubMed
Close
https://orcid.org/0000-0001-9961-4739
Restricted access

Adherence to prescribed exercise poses significant challenges for older adults despite proven benefits. The aim of this exploratory descriptive qualitative study was to explore the perceived barriers to and facilitators of prescribed home exercise adherence in community-dwelling adults 65 years and older. Three focus groups with 17 older adults (Mage ± SD = 77 ± 5.12) living in Singapore were conducted. Inductive thematic analysis revealed that “the level of motivation” of individuals constantly influenced their exercise adherence (core theme). The level of motivation appeared to be a fluid concept and changed due to interactions with two subthemes: (a) individual factors (exercise needs to be tailored to the individual) and (b) environmental factors (i.e., support is essential). Hence, these factors must be considered when designing strategies to enhance exercise adherence in this vulnerable population. Strategies must be informed by the culturally unique context, in this case, a developed country with a multiethnic urban Asian population.

  • Collapse
  • Expand
  • Abraham, C., & Sheeran, P. (2007). The health belief model. In A. Baum, C. McManus, J. Weinman, K. Wallston, R. West, S. Newman, & S. Ayers (Eds.), Cambridge handbook of psychology, health and medicine (2nd ed., pp. 97102). Cambridge University Press.

    • Search Google Scholar
    • Export Citation
  • Ang, S.G.M., O’Brien, A.P., & Wilson, A. (2019). Understanding carers’ fall concern and their management of fall risk among older people at home. BMC Geriatrics, 19(1), 144. https://doi.org/10.1186/s12877-019-1162-7

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Aw, S., Koh, G., Oh, Y.J., Wong, M.L., Vrijhoef, H.J.M., Harding, S.C., … Hildon, Z.J.L. (2017). Explaining the continuum of social participation among older adults in Singapore: From “closed doors” to active ageing in multi-ethnic community settings. Journal of Aging Studies, 42, 4655. https://doi.org/10.1016/j.jaging.2017.07.002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191215. https://doi.org/10.1037//0033-295x.84.2.191

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bandura, A., & Schunk, D.H. (1981). Cultivating competence, self-efficacy, and intrinsic interest through proximal self-motivation. Journal of Personality and Social Psychology, 41(3), 586598. https://doi.org/10.1037/0022-3514.41.3.586

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bennell, K., Nelligan, R.K., Schwartz, S., Kasza, J., Kimp, A., Crofts, S.J., & Hinman, R.S. (2020). Behavior change text messages for home exercise adherence in knee osteoarthritis: Randomized trial. Journal of Medical Internet Research, 22(9), Article e21749. https://doi.org/10.2196/21749

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Boulton, E.R., Horne, M., & Todd, C. (2018). Multiple influences on participating in physical activity in older age: Developing a social ecological approach. Health Expectations : An International Journal of Public Participation in Health Care and Health Policy, 21(1), 239248. https://doi.org/10.1111/hex.12608

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77101. https://doi.org/10.1191/1478088706qp063oa

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11(4), 589597. https://doi.org/10.1080/2159676x.2019.1628806

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Braun, V., & Clarke, V. (2020). One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Research in Psychology, 18(3), 328352. https://doi.org/10.1080/14780887.2020.1769238

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bunn, F., Dickinson, A., Barnett-Page, E., McInnes, E., & Horton, K. (2008). A systematic review of older people’s perceptions of facilitators and barriers to participation in falls-prevention interventions. Ageing & Society, 28, 449472. https://doi.org/10.1017/S0144686X07006861

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cajamarca, G., Herskovic, V., & Rossel, P.O. (2020). Enabling older adults’ health self-management through self-report and visualization—A systematic literature review. Sensors, 20(15), Article 4348. https://doi.org/10.3390/s20154348

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Carlsen, B., & Glenton, C. (2011). What about N? A methodological study of sample-size reporting in focus group studies. BMC Medical Research Methodology, 11(1), 26. https://doi.org/10.1186/1471-2288-11-26

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Chan, A., Malhotra, C., Malhotra, R., & Ostbye, T. (2011). Living arrangements, social networks and depressive symptoms among older men and women in Singapore. International Journal of Geriatric Psychiatry, 26(6), 630639. https://doi.org/10.1002/gps.2574

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Chan, A., Malhotra, C., Malhotra, R., Rush, A.J., & Ostbye, T. (2013). Health impacts of caregiving for older adults with functional limitations: Results from the Singapore survey on informal caregiving. Journal of Aging and Health, 25(6), 9981012. https://doi.org/10.1177/0898264313494801

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Forkan, R., Pumper, B., Smyth, N., Wirkkala, H., Ciol, M.A., & Shumway-Cook, A. (2006). Exercise adherence following physical therapy intervention in older adults with impaired balance. Physical Therapy, 86(3), 401410. https://doi.org/10.1093/ptj/86.3.401

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Franklin, M.D., Schlundt, D.G., McClellan, L.H., Kinebrew, T., Sheats, J., Belue, R., … Hargreaves, M. (2007). Religious fatalism and its association with health behaviors and outcomes. American Journal of Health Behavior, 31(6), 563572. https://doi.org/10.5555/ajhb.2007.31.6.563

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gee, C., Arivalagan, Y., & Chao, F. (Eds.). (2019). Singapore perspectives 2018: Together. World Scientific Publishing Co Pte Ltd.

  • Goodwin, V., & Briggs, L. (2012). Guidelines for the physiotherapy management of older people at risk of falling. AGILE: Chartered Physiotherapists Working With Older People. http://agile.csp.org.uk/documents/guidelines-physiotherapy-management-older-people-risk-falling?networkid=338430

    • Search Google Scholar
    • Export Citation
  • Haas, R., Mason, W., & Haines, T.P. (2014). Difficulties experienced in setting and achieving goals by participants of a falls prevention programme: A mixed-methods evaluation. Physiotherapy Canada, 66(4), 413422. https://doi.org/10.3138/ptc.2013-30BC

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hawley, H. (2009). Older adults’ perspectives on home exercise after falls rehabilitation: Understanding the importance of promoting healthy, active ageing. Health Education Journal, 68(3), 207218. https://doi.org/10.1177/0017896909339533

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Henwood, K., & Pidgeon, N. (2003). Grounded theory in psychological research. In: P.M. Camic, J.E. Rhodes, & L. Yardley (Eds.), Qualitative research in psychology: Expanding perspectives in methodology and design. APA. https://doi.org/10.1037/10595-008

    • Search Google Scholar
    • Export Citation
  • Hill, A.M., Hoffmann, T., McPhail, S., Beer, C., Hill, K.D., Brauer, S.G., & Haines, T.P. (2011). Factors associated with older patients’ engagement in exercise after hospital discharge. Archives of Physical Medicine and Rehabilitation, 92(9), 13951403. https://doi.org/10.1016/j.apmr.2011.04.009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hill, K.D., Suttanon, P., Lin, S.I., Tsang, W.W.N., Ashari, A., Hamid, T.A.A., … Burton, E. (2018). What works in falls prevention in Asia: A systematic review and meta-analysis of randomized controlled trials. BMC Geriatrics, 18(1), 3. https://doi.org/10.1186/s12877-017-0683-1

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Horne, M., Skelton, D.A., Speed, S., & Todd, C. (2014). Falls prevention and the value of exercise: Salient beliefs among South Asian and white British older adults. Clinical Nursing Research, 23(1), 94110. https://doi.org/10.1177/1054773813488938

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Horne, M., Speed, S., Skelton, D., & Todd, C. (2009). What do community-dwelling Caucasian and South Asian 60–70 year olds think about exercise for fall prevention? Age and Ageing, 38(1), 6873. https://doi.org/10.1093/ageing/afn237

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Horne, M., & Tierney, S. (2012). What are the barriers and facilitators to exercise and physical activity uptake and adherence among South Asian older adults: A systematic review of qualitative studies. Preventive Medicine, 55(4), 276284. https://doi.org/10.1016/j.ypmed.2012.07.016

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hughes, K.J., Salmon, N., Galvin, R., Casey, B., & Clifford, A.M. (2019). Interventions to improve adherence to exercise therapy for falls prevention in community-dwelling older adults: Systematic review and meta-analysis. Age and Ageing, 48(2), 185195. https://doi.org/10.1093/ageing/afy164

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hunter, D., McCallum, J., & Howes, D. (2019). Defining exploratory-descriptive qualitative (EDQ) research and considering its application to healthcare. Journal of Nursing and Health Care, 4(1), Article E180272. http://eprints.gla.ac.uk/180272

    • Search Google Scholar
    • Export Citation
  • Jackson, C., Eliasson, L., & Weinman, J. (2014). Applying COM-B to medication adherence: A suggested framework for research and interventions. The European Health Psychologist, 16(1), 716.

    • Search Google Scholar
    • Export Citation
  • Jang, H., Clemson, L., Lovarini, M., Willis, K., Lord, S.R., & Sherrington, C. (2016). Cultural influences on exercise participation and fall prevention: A systematic review and narrative synthesis. Disability and Rehabilitation, 38(8), 724732. https://doi.org/10.3109/09638288.2015.1061606

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kayes, N.M., McPherson, K.M., Taylor, D., Schluter, P.J., & Kolt, G.S. (2011). Facilitators and barriers to engagement in physical activity for people with multiple sclerosis: A qualitative investigation. Disability and Rehabilitation, 33(8), 625642. https://doi.org/10.3109/09638288.2010.505992

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kerr, C., Nixon, A., & Wild, D. (2010). Assessing and demonstrating data saturation in qualitative inquiry supporting patient-reported outcomes research. Expert Review of Pharmacoeconomics & Outcomes Research, 10(3), 269281. https://doi.org/10.1586/erp.10.30

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Krueger, R.A., & Casey, A.M. (2015). Focus groups: A practical guide for applied research (5th ed.). SAGE Publications, Inc.

  • Lachman, M.E., Jette, A.M., Tennstedt, S., Howland, J., Harris, B.A., & Peterson, E. (1997). A cognitive-behavioural model for promoting regular physical activity in older adults. Psychology, Health & Medicine, 2(3), 251261. https://doi.org/10.1080/13548509708400583

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lamb, S.E., Jorstad-Stein, E.C., Hauer, K., Becker, C., Prevention of Falls Network Europe, & Outcomes Consensus Group. (2005). Development of a common outcome data set for fall injury prevention trials: The prevention of falls network Europe consensus. Journal of the American Geriatrics Society, 53(9), 16181622. https://doi.org/10.1111/j.1532-5415.2005.53455.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Linton, E., Gubhaju, B., & Chan, A. (2018). Home alone: Older adults in Singapore. Centre for Ageing Research and Education (CARE). http://scholarbank.nus.edu.sg/handle/10635/148603

    • Search Google Scholar
    • Export Citation
  • Mahoney, M.J., & Thoresen, C.E. (1972). Behavioral self-control: Power to the person. Educational Researcher, 1(10), 57. https://doi.org/10.3102/0013189X001010005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mansson, L., Lundin-Olsson, L., Skelton, D.A., Janols, R., Lindgren, H., Rosendahl, E., & Sandlund, M. (2020). Older adults’ preferences for, adherence to and experiences of two self-management falls prevention home exercise programmes: A comparison between a digital programme and a paper booklet. BMC Geriatrics, 20(1), 209. https://doi.org/10.1186/s12877-020-01592-x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • McClain, C. (2005). Collaborative rehabilitation goal setting. Topics in Stroke Rehabilitation, 12(4), 5660. https://doi.org/10.1310/ELB1-EGKF-QUQC-VFE9

    • Crossref
    • Search Google Scholar
    • Export Citation
  • McLeroy, K.R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351377. https://doi.org/10.1177/109019818801500401

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Michie, S., Atkins, L., & West, R. (2014). The behaviour change wheel: A guide to designing interventions. Silverback Publishing.

  • Morgan, D.L., & Krueger, R.A. (1993). Successful Focus Groups: Advancing the State of the Art. SAGE Publications, Inc.

  • Neergaard, M.A., Olesen, F., Andersen, R.S., & Sondergaard, J. (2009). Qualitative description—The poor cousin of health research? BMC Medical Research Methodology, 9, 52. https://doi.org/10.1186/1471-2288-9-52

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Neupert, S.D., Lachman, M.E., & Whitbourne, S.B. (2009). Exercise self-efficacy and control beliefs: Effects on exercise behavior after an exercise intervention for older adults. Journal of Aging and Physical Activity, 17(1), 116. https://doi.org/10.1123/japa.17.1.1

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nyman, S.R., & Victor, C.R. (2012). Older people’s participation in and engagement with falls prevention interventions in community settings: An augment to the Cochrane systematic review. Age and Ageing, 41(1), 1623. https://doi.org/10.1093/ageing/afr103

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Olij, B.F., Barmentloo, L.M., Smilde, D., van der Velde, N., Polinder, S., Schoon, Y., & Erasmus, V. (2019). Factors associated with participation of community-dwelling older adults in a home-based falls prevention program. International Journal of Environmental Research and Public Health, 16(6), Article 1087. https://doi.org/10.3390/ijerph16061087

    • Search Google Scholar
    • Export Citation
  • Orzech, K.M., Vivian, J., Huebner Torres, C., Armin, J., & Shaw, S.J. (2013). Diet and exercise adherence and practices among medically underserved patients with chronic disease: Variation across four ethnic groups. Health Education & Behavior, 40(1), 5666. https://doi.org/10.1177/1090198112436970

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Panagioti, M., Richardson, G., Small, N., Murray, E., Rogers, A., Kennedy, A., … Bower, P. (2014). Self-management support interventions to reduce health care utilisation without compromising outcomes: A systematic review and meta-analysis. BMC Health Services Research, 14, Article 356. https://doi.org/10.1186/1472-6963-14-356

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Picorelli, A.M., Pereira, L.S., Pereira, D.S., Felicio, D., & Sherrington, C. (2014). Adherence to exercise programs for older people is influenced by program characteristics and personal factors: A systematic review. Journal of Physiotherapy, 60(3), 151156. https://doi.org/10.1016/j.jphys.2014.06.012

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rimmer, J.H. (2006). Use of the ICF in identifying factors that impact participation in physical activity/rehabilitation among people with disabilities. Disability and Rehabilitation, 28(17), 10871095. https://doi.org/10.1080/09638280500493860

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rozario, P.A., & Hong, S.I. (2019). Foreign domestic workers and eldercare in Singapore: Who hires them? Journal of Aging & Social Policy, 31(3), 197210. https://doi.org/10.1080/08959420.2019.1578605

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ryan, R.M., & Deci, E.L. (2000). Intrinsic and extrinsic motivations: Classic definitions and new directions. Contemporary Educational Psychology, 25(1), 5467. https://doi.org/10.1006/ceps.1999.1020

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sabaté, E. (2003). Adherence to long-term therapies: Evidence for action. World Health Organization.

  • Sandelowski, M. (1993). Theory unmasked: The uses and guises of theory in qualitative research. Research in Nursing & Health, 16(3), 213218. https://doi.org/10.1002/nur.4770160308

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sandelowski, M. (2000). Whatever happened to qualitative description? Research in Nursing & Health, 23(4), 334340.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Seron, P., Oliveros, M.J., Gutierrez-Arias, R., Fuentes-Aspe, R., Torres-Castro, R.C., Merino-Osorio, C., … Sanchez, P. (2021). Effectiveness of telerehabilitation in physical therapy: A rapid overview. Physical Therapy, 101(6), Article pzab053. https://doi.org/10.1093/ptj/pzab053

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Shenton, A.K. (2004). Strategies for ensuring trustworthiness in qualitative research projects. Education for Information, 22(2), 6375. https://doi.org/10.3233/efi-2004-22201

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sherrington, C., Fairhall, N., Kwok, W., Wallbank, G., Tiedemann, A., Michaleff, Z.A., … Bauman, A. (2020). Evidence on physical activity and falls prevention for people aged 65+ years: Systematic review to inform the WHO guidelines on physical activity and sedentary behaviour. The International Journal of Behavioral Nutrition and Physical Activity, 17(1), 144. https://doi.org/10.1186/s12966-020-01041-3

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sherrington, C., & Tiedemann, A. (2015). Physiotherapy in the prevention of falls in older people. Journal of Physiotherapy, 61(2), 5460. https://doi.org/10.1016/j.jphys.2015.02.011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Simek, E.M., McPhate, L., & Haines, T.P. (2012). Adherence to and efficacy of home exercise programs to prevent falls: A systematic review and meta-analysis of the impact of exercise program characteristics. Preventive Medicine, 55(4), 262275. https://doi.org/10.1016/j.ypmed.2012.07.007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tan, P.L. (2018). Dual burdens of care: “Sandwiched Couples” in East Asia. Journal of Aging and Health, 30(10), 15741594. https://doi.org/10.1177/0898264318796061

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Teixeira, P.J., Carraca, E.V., Markland, D., Silva, M.N., & Ryan, R.M. (2012). Exercise, physical activity, and self-determination theory: A systematic review. The International Journal of Behavioral Nutrition and Physical Activity, 9(1), 78. https://doi.org/10.1186/1479-5868-9-78

    • Crossref
    • Search Google Scholar
    • Export Citation
  • West, R., & Michie, S. (2020). A brief introduction to the COM-B model of behaviour and the PRIME theory of motivation. Qeios. https://doi:10.32388/WW04E6.2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Williams, G.C., Rodin, G.C., Ryan, R.M., Grolnick, W.S., & Deci, E.L. (1998). Autonomous regulation and long-term medication adherence in adult outpatients. Health Psychology, 17(3), 269276. https://doi.org/10.1037//0278-6133.17.3.269

    • Crossref
    • Search Google Scholar
    • Export Citation
  • World Health Organization. (2001). International classification of functioning, disability and health: ICF.

  • Yardley, L., Beyer, N., Hauer, K., McKee, K., Ballinger, C., & Todd, C. (2007). Recommendations for promoting the engagement of older people in activities to prevent falls. Quality & Safety in Health Care, 16(3), 230234. https://doi.org/10.1136/qshc.2006.019802

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Yardley, L., Bishop, F.L., Beyer, N., Hauer, K., Kempen, G.I., Piot-Ziegler, C., … Holt, A.R. (2006). Older people’s views of falls-prevention interventions in six European countries. The Gerontologist, 46(5), 650660. https://doi.org/10.1093/geront/46.5.650

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Yeoh, B.S., & Huang, S. (2010). Foreign domestic workers and home-based care for elders in Singapore. Journal of Aging & Social Policy, 22(1), 6988. https://doi.org/10.1080/08959420903385635

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 1939 1673 40
Full Text Views 107 97 8
PDF Downloads 141 124 11