Open Access

Systematic mapping review of the factors influencing physical activity and sedentary behaviour in ethnic minority groups in Europe: a DEDIPAC study

  • Lars Jørun Langøien1,
  • Laura Terragni2,
  • Gro Rugseth1,
  • Mary Nicolaou3,
  • Michelle Holdsworth4,
  • Karien Stronks3,
  • Nanna Lien5,
  • Gun Roos6Email authorView ORCID ID profile and
  • on behalf of the DEDIPAC consortium
International Journal of Behavioral Nutrition and Physical Activity201714:99

https://doi.org/10.1186/s12966-017-0554-3

Received: 5 December 2016

Accepted: 12 July 2017

Published: 24 July 2017

Abstract

Background

Physical activity and sedentary behaviour are associated with health and wellbeing. Studies indicate that ethnic minority groups are both less active and more sedentary than the majority population and that factors influencing these behaviours may differ. Mapping the factors influencing physical activity and sedentary behaviour among ethnic minority groups living in Europe can help to identify determinants of physical activity and sedentary behaviour, research gaps and guide future research.

Methods

A systematic mapping review was conducted to map the factors associated with physical activity and sedentary behaviour among ethnic minority groups living in Europe (protocol PROSPERO ID = CRD42014014575). Six databases were searched for quantitative and qualitative research published between 1999 and 2014. In synthesizing the findings, all factors were sorted and structured into clusters following a data driven approach and concept mapping.

Results

Sixty-three articles were identified out of 7794 returned by the systematic search. These included 41 quantitative and 22 qualitative studies. Of these 58 focused on physical activity, 5 on both physical activity and sedentary behaviour and none focused on sedentary behaviour. The factors associated with physical activity and sedentary behaviour were grouped into eight clusters. Social & cultural environment (n = 55) and Psychosocial (39) were the clusters containing most factors, followed by Physical environment & accessibility (33), Migration context (15), Institutional environment (14), Social & material resources (12), Health and health communication (12), Political environment (3). An important finding was that cultural and religious issues, in particular those related to gender issues, were recurring factors across the clusters.

Conclusion

Physical activity and sedentary behaviour among ethnic minority groups living in Europe are influenced by a wide variety of factors, especially informed by qualitative studies. More comparative studies are needed as well as inclusion of a wider spectrum of the diverse ethnic minority groups resettled in different European countries. Few studies have investigated factors influencing sedentary behaviour. It is important in the future to address specific factors influencing physical activity and sedentary behaviour among different ethnic minority groups in order to plan and implement effective interventions.

Keywords

Physical activity Sedentary behaviour Factors Ethnic minority groups Europe Migrants Immigrants

Background

Low levels of physical activity (PA) and high levels of sedentary behaviour (SB) are associated with obesity and non-communicable diseases (NCDs), including type 2 diabetes and cardiovascular diseases (WHO, 2014). Enhancing the levels of PA and reducing the levels of SB can prevent and to some extent treat NCDs. Studies indicate that some ethnic minority groups are less active and more sedentary than the majority population and that factors influencing these behaviours may differ (e.g. [13]). In Europe, reviews have been undertaken on obesity and PA among a limited number of ethnic minority or migrant groups. These include reviews of PA in North African migrants [4] and South Asian women in different Western countries [5]. These reviews mainly focused on levels of PA, and indicated that information on barriers and facilitators is limited. However, to develop effective interventions that also reach ethnic minority groups information about factors influencing PA and SB is necessary. To our knowledge there are no systematic reviews on factors influencing PA and SB in ethnic minority groups across Europe. The ethnic minority groups in Europe are quite diverse in terms of size, country of origin and migration patterns, and there are substantial variations between countries [6]. In recent years the number of asylum seekers have increased and the three largest groups have been from Syria, Afghanistan and Iraq [7]. Refugees, asylum seekers and migrants seem to be at risk for worse health outcomes including NCDs [8]. As the migrant composition in Europe is changing and growing, gathering knowledge on factors influencing PA and SB of migrants and identifying gaps in the literature is crucial for assessing the needs of these populations and planning interventions.

The aim of this study was to systematically review the literature that has identified factors influencing PA and SB across the life-course among ethnic minority groups living in Europe, uncover gaps in the literature and suggest priorities for future research. This review is part of the work performed on ethnic minority groups in the DEDIPAC (Determinants of Diet and Physical Activity) Knowledge Hub [9]. DEDIPAC KH is a European research network aiming at understanding the ‘causes of the causes’ of diet, physical activity and sedentary behaviour. The evidence from this review also feeds into a DEDIPAC study of factors influencing diet and PA/SB behaviours in ethnic minority groups in Europe [10].

Methods

We conducted a systematic mapping review to find both quantitative and qualitative published literature. According to Grant and Booth [11] mapping reviews are suited to map out the existing literature to identify tendencies and gaps in the research literature to commission future research. The review protocol was registered with PROSPERO (ID = CRD42014014575).

The stages of the data selection process are presented in Fig. 1. The search was conducted in the following electronic databases: MEDLINE, EMBASE (Ovid), Web of Science, Cochrane Library, CINAHL, Psychinfo (Ovid). The databases were searched from 1999 to 2014. This time period was chosen because we anticipated that factors identified before 1999 would be referred to in more recent literature. The citation follow–up technique was used to identify studies that had not been identified through the systematic search of the databases. Additionally, experts in the subject area, researchers working in the fields of physical activity and sedentary behaviour, ethnicity and health were contacted to identify relevant studies that might have been missed in the search of electronic databases.
Fig. 1

PRISMA flow chart: Selection process for articles

Ethnic minority group is a concept used for very heterogeneous groups that may share minority status in their country of residence due to ethnicity, place of birth, language, religion, citizenship as well as other cultural differences. This definition may include groups from newly arrived immigrants to (minority) groups that have been part of a country’s history, for instance the Roma and Sami people. Within the DEDIPAC consortium we reached an agreement on what we meant by ‘Ethnic minority groups’, who were defined as immigrants/populations of immigrant background (not differentiating based on their migration status) from low and middle income countries, population groups from the former Eastern Bloc countries who migrate to other parts of Europe and minority indigenous populations in Europe [9]. We decided to focus on these ethnic minority groups because they are more likely to be of lower socioeconomic status.

Inclusion and exclusion criteria

Observational and intervention studies using quantitative and/or qualitative methods examining physical activity and sedentary behaviour among ethnic minority groups in Europe were included. In addition, studies that identified an association between a factor (including correlates, predictors, moderators, determinants and mediators) and physical activity or sedentary behaviour of ethnic minority groups living in Europe were included. All age groups were included.

Studies that analysed physical activity or sedentary behaviour as a confounder in a relationship between ethnicity and disease, including studies that explored whether ethnicity is a factor influencing physical activity or sedentary behaviour without explanation were excluded because we were interested in studies that contained relevant information on factors. Studies only presenting descriptive information about physical activity or sedentary behaviour, or just describing levels of activity according to belonging to an ethnic minority group without providing any explanation were also excluded. As were non-human studies and laboratory based studies.

Search strategy and study selection

A search strategy was constructed to identify studies with the use of free text word and MESH terms, which was modified for each database. The search strategy was guided by search terms within three concepts: physical activity and/or sedentary behaviour; ethnic minority group; and Europe (as the setting). The complete strategy is shown in Additional file 1. Retrieved literature was stored in an Endnote database and duplicate entries were deleted.

To ensure accuracy and consistency of data extraction two reviewers (LJL and LT) independently screened titles and abstracts of identified studies for relevance, according to the review inclusion criteria. Spot checks were conducted on a sample of screened sources to assess the extent of agreement between reviewers. All retrieved full texts papers were reviewed by two of the team of four independent researchers (GrR and LJL or LT and GR).

Data extraction and synthesis

Data from papers included in the full text review phase were extracted by four independent researchers (LJL, LT, GrR and GR). An extraction tool was developed to collate data which was used to identify general information and study characteristics (author, year of publication, country, and study design, sample size), population characteristics (gender, age, country of origin, years since migration, acculturation, education, migration history, and other relevant demographics).

Quality assessment of quantitative and qualitative studies was undertaken using established quality assessment criteria for evaluating primary research papers [12]. The quality of articles included after the full text review were assessed by two of the team of four independent researchers involved in data extraction. The quality assessment scores given to the included studies are included in Tables 1 and 2.
Table 1

Study characteristics of quantitative studies (N = 41)

Author

Study design

Study population

Sample characteristics

Number of participants

Setting, country

Recruitment

Physical activity (PA), Sedentary Behaviours (SB)

Measurement

Quality score

Andersen et al., 2011 [65]

RCT

Pakistani immigrant men

25–60 years

150

Oslo, Norway

Mosques and Muslim festivals

PA

Accelerometer, treadmill, questionnaire

20/22

Andersen et al., 2013

[50]

RCT

Pakistani immigrant men

25–60 years

126

Oslo, Norway

Mosques and Muslim festivals

PA

Accelerometer

21/24

Arvidson et al., 2014

[55]

Cross sectional

Iraqis and Swedes

30–75 years

599 Iraqis

553 Swedes

Malmö, Sweden

Randomly selected from the census register

PA

Self-report, accelerometer

20/22

Babakus et al., 2012 [5]

Review

South Asian women

18 years and older

26 quantitative 12 qualitative studies

UK, US, Canada, Australia, Norway, India, New Zealand, Guadeloupe

Various

PA, SB

Various

18/18

Besharat Pour et al.,

2014 [77]

Cross sectional

Children of immigrants and Swedish parents

8 years

2589

21.7% one or two immigrant parents

Stockholm, Sweden

Prospective birth cohort study BAMSE

PA

Parental questionnaire

22/22

Dawson et al., 2005

[21]

Cross sectional

Born in Sweden, Western Europe, Finland, Southern Europe, Eastern Europe, other countries

20–74 years

7172 men (699 immigrants)

7313 women (799 immigrants)

Sweden

General population

PA

Questionnaire

21/22

De Munter et al., 2012 [67]

Cross

sectional

South Asian-Surinamese, African-Surinamese and European-Dutch

35–60 years

370 South Asian-Surinamese, 689 African-Surinamese, 567 European-Dutch

Amsterdam, The Netherlands

Random sample from the population register

Leisure-time PA and active commuting

Interview questionnaire,

physical examination

21/22

De Munter et al., 2013 [73]

Cross sectional

European, Indian, African-Caribbean

36–60 years

European (English = 14,723, Dutch = 567),

Indian (E = 1264, D = 370),

African –Caribbean

(E = 1112, D = 689)

Amsterdam, The Netherlands and

England

Random sample from the population register

Leisure-time PA

Questionnaire

19/22

Drenowatz, et al., 2013 [56]

Cross sectional

Parent born outside Germany or foreign language spoken during the child’s first years

8 years

995

Southern Germany

Representative sample of children from 32 schools participating in an intervention

PA, physical fitness, sport

General motor abilities test for children. Parental questionnaire for participation in organized sports

21/22

Edwardson et al., 2014 [51]

Cross sectional

General population, multi-ethnic sample of students

11–14 years

588 girls

578 boys

The East Midlands, England

Multi-ethnic representative sample of students from 5 schools. Schools recruited based on SES

PA, activity-related social support

Questionnaire

21/22

Garduño-Diaz et al.,

2013 [22]

Cross sectional

African-Caribbean, South Asian, Caucasian groups in the UK

20 years and older

210

Leeds, England

Random sample - three area codes in Leeds

PA

Questionnaire

20/22

Gele et al., 2013 [62]

Cross sectional

Somali immigrants

25 years and older

115 women

93 men

Oslo, Norway

Non-random snowball sampling

PA

Questionnaire

21/22

Gualdi-Russo et al.,

2014 [4]

Review

North African children living in their home countries or as immigrants in Europe

0–21 years

Various

European countries

Various

PA

Various

17/20

Hansen et al., 2008 [72]

Cross sectional

Non-Western immigrants with Danish citizenship compared with citizens with Danish background

25–64 years

135

(Turkey, Bosnia, Sri Lanka, Iran, Lebanon, Vietnam, Pakistan, Palestine, India, Croatia, Egypt)

Denmark

Based on National Health Interview Survey 2005

PA, SB

 

20/22

Hayes et al.,

2002 [61]

Cross sectional

European, Indian, Pakistani and Bangladeshi residents

General population, 25–75 years

825 Europeans, 684 Indian, Pakistani or Bangladeshi

Newcastle upon Tyne, England

Random selection

PA, SB

Questionnaire

20/22

Hermansen et al., 2002 [66]

Cross sectional

People of Norse and Sami origin (indigenous)

All residents, 40–62 years

860 women

866 men

of Sami origin

3948 women 4105 men of Norse origin

Finnmark county, Norway

Invited by personal letter with questionnaire

PA, leisure-time and work

Questionnaire

20/22

Hornby-Turner et al., 2014 [24]

Cross sectional

British-Pakistani and White British girls

9–11 years

70 White British

75 British Pakistani

(+ parents of 19 girls)

North East England

Approached 8 primary schools. Parents of participating children asked by letter to participate in interview

PA, SB

Questionnaire, PA interview, Accelerometer

19/22

Hosper et al., 2007 [59]

Cross sectional

First and second generation Turkish young people

15–30 years

249 women

236 men

Amsterdam, The Netherlands

Random sample drawn from Amsterdam population registry

Leisure-time PA

Structured interview,

Questionnaire

20/22

Hosper et al.,

2008 [53]

Cross sectional

Turkish and Moroccan women

15–30 years

258 Turkish

170 Moroccan women

Amsterdam, The Netherlands

Random sample drawn from the Amsterdam population registry

PA, sport, leisure-time PA

Questionnaire

21/22

Jönsson et al., 2012 [71]

Cross sectional

Women living in Sweden (born in Finland, Chile and Iraq)

18–65 years

1651 women

Stockholm and Botkyrka, Sweden

Random sample drawn from the population registers

Leisure-time PA

Postal questionnaire

20/22

Khunti et al., 2007 [29]

Cross sectional

5 schools

11–15 years

3601

Leicester, England

Representative sample through schools

PA

Questionnaire

20/22

Koca et al., 2014 [30]

Cross sectional

Turkish migrants in Germany and England

Adults, (first, second, third generation)

Germany:

140 women

126 men

England:

125 women

125 men

Frankfurt, Germany,

London, UK

Convenience sample. Recruited from migrant organizations

PA level

Questionnaire, face-to-face interview

20/22

Kumanyika et al., 2012 [57]

Review

African descent populations in English-speaking countries, other ethnic minority populations

  

U.S, New Zealand, Canada and Europe

 

PA resources, facilities, opportuni-ties

Interdisciplinary group discussions

15/18

Kumar et al., 2006 [69]

Cross sectional

Ethnic minority groups (born in Turkey, Iran, Pakistan, Sri Lanka, Vietnam)

Born in 1942–1970

1320 women

1679 men

Oslo, Norway

2001 population registry - invited to participate

Leisure-time PA

Health questionnaire, clinical screening

20/22

Lecerof et al., 2011 [63]

Cross sectional

Recently settled Iraqi migrants in Sweden

18–64 years

306 women

273 men

Sweden

All adults born in Iraq who were registered in 8 counties (Dec 2007 – Feb 2008)

PA

Postal questionnaire

19/20

Lindström et al., 2001 [44]

Cross sectional

Malmö general population (83 different countries of origin)

20–80 years

1916 women 1872 men

Malmö, Sweden

Random sample. General population in 1994 (born in 1913, 1923, 1933, 1943, 1953, 1963, 1968, 1973)

Leisure-time PA

Postal questionnaire

20/20

Magnusson et al., 2005 [64]

Cross sectional

Children in grades 5 and 6

11–12 years

108

Community (6700 inhabitants) near Gothenburg, Sweden

All children in grades 5 and 6 at a Swedish school

PA, exercise

Questionnaire, individual interview

19/22

Me’jean et al., 2009 [74]

Retrospective cohort study

Tunisian migrant men

Mean 50 years

150 men

South France

Quota sampling based on age and place of residence

PA

Interview, questionnaire

22/22

Molaodi et al., 2012 [80]

Environment - modelling

White British, Black Africans, Black Caribbean, Indians, Pakistanis, Bangladeshis, Chinese and Irish

Deprived areas

 

UK

 

Physical activity facilities

Lists from Sport England

21/22

Nielsen et al., 2013 [60]

Cross sectional

Children with other ethnic background than Danish

Pre-school age and same children in third grade

Preschool 67 other ethnic background of 594; third grade 58 of 518

Taarnby and Ballerup, Copenhagen

Children from 18 schools in Taarnby and Ballerup were invited

Habitual PA

Accelerometer, parental questionnaire

22/22

Nilsson et al., 2011 [76]

Cohort study

Elderly Sami

60 years and older

9 women

11 men

81 reindeer-herding and 226 non-reindeer-herding Sami

Southern Lapland.

Västerbotten county

Suggested by local associations, invited by posted letter.

Västerbotten intervention project cohorts 40, 50, 60 years

PA

Semi-structured interviews, questionnaire

22/22

Owen et al., 2009 [33]

Cross sectional

British children of South Asian, black African-Caribbean and white European origin

9–10 years

N = 1841

(562 white Europeans, 494 South Asians, 607 African-Caribbeans, 408 other ethnic groups)

London, Birmingham, Leicester, UK

Random samples (all state primary schools in London, Birmingham and Leicester with 15–50% pupils of White European origin)

PA

Accelerometer

22/22

Pudaric et al., 2000 [35]

Cross sectional

Elderly foreign-born persons

55–74 years

159 women

94 men

Sweden

Random sample drawn from Swedish Population Registry

PA

Face-to-face interview

22/22

Reijneveld et al., 2003 [36]

RCT

Turkish immigrants

45 years and older

41 women

51 men

The Netherlands - 6 cities

Welfare services

PA

Self-report

19/24

Sagatun et al., 2008 [37]

Longitudinal

10th grade in Oslo in 1999–2001

15–16 years (follow up 18–19 years)

1377 girls

1112 boys

Oslo, Norway

All students in grade 10

Leisure-time PA

Questionnaire

21/22

Saris et al., 2013 [68]

Cross sectional

Adults in deprived neighbourhoods (39.7% migrants - mainly non-Western)

18 years and older

337 women

285 men

The Netherlands

Randomly selected adults in 20 most deprived neighbourhoods

Active transport

Questionnaire, interview

22/22

Södergren et al., 2010 [46]

Cross sectional

Women born in Sweden, Finland, Chile and Iraq

18–65 years

2649 women

Stockholm, Sweden

Random sample from population registers in 2 municipalities of Stockholm

PA

Postal questionnaire

20/22

van Rossem et al., 2012 [75]

Cohort

Children at age 3 enrolled in a birth cohort

 

2351 girls

2337 boys

Rotterdam, The Netherlands

All pregnant mothers with expected delivery April 2002–January 2006

PA, SB

Parental questionnaire

19/22

Walseth et al., 2004 [42]

Review

Minority women

    

Sport

 

11?

Williams et al., 2010 [70]

Cross sectional

South Asian and White

18–55 years

5421 South Asian

8974 White

UK

 

PA

Leisure activities/sports, domestic activities, walking

 

20/20

Yates et al., 2010 [54]

Cross sectional

White European and South Asians

White European: 40–75 years

South Asians: 25–75 years

White European:

2277 women 2033 men

South Asians:

560 women

604 men

Leicester, UK

Primary care

PA

Questionnaire

21/22

Study design: RCT Random Control Trial

Table 2

Study characteristics of qualitative studies (N = 22)

Author

Study design

Study population

Sample characteristics

Number of participants

Setting, country

Recruitment

Physical activity (PA), Sedentary Behaviours (SB)

Measurement

Quality score

Benn et al., 2013 [18]

Case studies

Muslim girls and stakeholders

England: 8 state schools

Denmark: One class, 16–17 years

England:

109 female students

19 teachers

32 parents

Denmark:

42 female and male students

England and Denmark

Representative sample

PA, Physical education

England: Qualitative survey, focus groups, semi-structured interview

Denmark: survey, video observation of sport/PE lessons, interview

16/20

Beune et al., 2010 [47]

Qualitative inductive

Ghanaians, African-Surinamese, White Dutch

 

26 women

20 men

(19 Ghanaian, 19 Surinamese, 16 White Dutch)

Amsterdam, The Netherlands

Purposive sampling through health-care centres

PA

 

19/20

Dagkas et al., 2006 [19]

Interpretive study

Greek Turkish girls and British Asian women, living in predominantly non-Muslim countries

Greek: 13–15 years

British: 18–21 years

Greek: 24 girls at school

British: 20 women at university

Greece and Great Britain

British group was participating in a larger life history project

PA, Physical education, sport

Semi-structured interview

16/20

Dagkas et al., 2011 [20]

Case studies

Muslim girls

5–16 year

109 girls

19 teachers

32 parents.

Additional focus groups - 36 girls

West Midlands, England

Representative sample of schools

PA, Physical education, school sport

Focus groups

19/20

Hendriks et al., 2012 [23]

Theoretical framework

Surinamese Immigrants of Indian (Hindustani) Descent

29–83 years, lived in The Netherlands for 25–39 years - feeling 100% Hindu

24 women

3 men

The Netherlands

Through community houses and yoga class. Snowball technique

PA

Semi-structured interview, focus groups

19/20

Horne et al., 2010 [58]

Ethnographic approach

Community dwelling White and South Asians

60–70 years

Focus groups: 87

Interviews: 40

The North West England

From a period of fieldwork observation in leisure groups and social centres

PA, exercise

Focus groups, in-depth interview

16/20

Horne e.t al., 2012a [25]

Ethnographic approach

South Asians

60–70 years

Focus groups: 29

Interviews: 17

UK

From a period of fieldwork observation in leisure groups and social settings

PA

Focus groups, in-depth interview

18/20

Horne et al.,

2012b [52]

Systematic review

South Asian older adults

 

10 studies

UK and Canada

 

PA

 

20/20

Horne et al., 2013 [26]

Exploratory qualitative approach

Community dwelling White and South Asians

60–70 years

 

The North West of England

Purposive sampling was used to recruit participants with different experiences of PA participation

PA, exercise

Focus groups and in-depth interview

16/20

Johnson,

2000 [27]

Survey, review of qualitative studies

South Asians

16–74 years

22 focus groups (14 with South Asians)

UK

 

PA

Focus groups

14/20

Kay, 2006 [28]

Interviews with women and their families

Young Muslim women

13–18 years

and their families

6 families.

7 women (Bangladeshi, black African, Arab)

Midland town, UK

 

PA, sport

Interview

18/20

Lawton et al., 2006 [31]

Qualitative in-depth interviews

Pakistani and Indian patients in Scotland diagnosed with Type 2 diabetes

Over 18 years, diagnosed with Type 2 diabetes

Pakistani:

12 women

11 men

Indian:

5 women

4 men

Edinburgh, Scotland

Both clinical and local community recruitment. Purposively sampled. Snowball sampling

PA

In-depth interview

15/17

Lucas et al., 2013 [40]

Review, meta-ethnographic approach

UK South Asian populations

Adults

10 qualitative studies

UK

 

PA, exercise

 

19/20

Nicolaou et al., 2012 [32]

Focus groups

Moroccan women

Women

Amsterdam:

4 focus groups (22 women)

Morocco:

4 focus groups (29 women)

Amsterdam, The Netherlands and Morocco

Amsterdam (Mother-child centre, women’s centre) and Morocco (Al Hoceima town, small village and medium sized village)

PA

Focus groups

20/20

Pallan et al., 2012 [34]

Focus groups with stakeholders

  

9 focus groups with 68 local community stakeholders

UK

Stakeholders from 8 school communities with predominantly South Asian pupils

PA

Focus groups

17/20

Pallan et al., 2013 [41]

Development of intervention

UK South Asian primary school-aged children

  

Birmingham, UK

 

PA

Focus groups, literature review, expert group, review of local resources

19/20

Pollard et al., 2012 [48]

Largely qualitative

British Pakistani women, Muslim

 

22 women

Newcastle upon Tyne, UK

Information event at leisure centre, snowball sampling

PA

Interview, accelerometer, 24 h recall

16/19

Rawlins et al., 2013 [45]

Focus groups

Black Caribbean, Black African, Indian, Pakistani, Bangladeshi and White British children and their parents

Schools: 11–12 years, 10–11 years;

Places of worship: 8–13 years and parents

39 female

31 male students

34 mothers

9 fathers

London boroughs (Brent, Croydon, Ealing, Hackney, Hillingdon, Lambeth)/UK

Schools or places of worship

Healthy lifestyles

Focus groups, interview

18/18

Sriskantharajah et al., 2007 [49]

Explorative qualitative

South Asian women (Indian, Pakistani, Bangladeshi, East African Asian, Sri Lankan)

26–70 years, CHD and diabetes type 2

15 women

UK

Purposive sampling: 3 general practices

PA,

exercise

Semi-structured interview

16/17??

Steinbach et al., 2011 [38]

Qualitative in-depth interviews, fieldwork

workplaces with a mixed workforce (ethnicity, income, age)

 

78

London, UK

Purposive sampling

Cycling for transport

Qualitative in-depth interview, fieldwork

14/16

Södergren et al., 2008 [39]

Explorative qualitative

Immigrant women from Chile, Iraq and Turkey

26–65 years

63 women

Stockholm, Sweden

Multi-recruitment strategy

PA, exercise

Focus groups

18/18

Walseth, 2006 [43]

Life-history

Muslim women with immigrant background (Pakistan, Turkey, Morocco, Iran, Syria, Somalia, Gambia, Macedonia, Kosovo)

16–25 years

21 women

Norway

Sampled through their former status as pupils at one elementary school in Oslo and through sport clubs

PA, Sport

Life-history interviews

19/20

Common methodologies for identifying and grouping factors were used as for a similar review on dietary determinants of ethnic minority groups [13]. First, all factors from the included studies were identified. Then these factors were sorted into clusters according to how they were seen to relate to each other, following a data driven approach [14]. The clustering was part of a larger concept mapping process with the aim of developing a system-based framework of factors influencing dietary behaviour and physical activity/sedentary behaviour in the general European population [1517] and in ethnic minority groups living in Europe (manuscript in preparation: [10]). For PA/SB the factors were grouped into eight clusters; Health & health communication, Political environment, Social & cultural environment, Psychosocial, Institutional environment, Physical environment & accessibility, Social & material resources and Migration context.

Results

Description of included studies

We identified 63 articles on PA and SB (41 based on quantitative studies; 22 on qualitative) among ethnic minority groups in Europe (Fig. 1). It should be noted that we in some cases have chosen to include more than one article from the same study, or research populations, when the articles address different issues, or mention different factors of PA or SB. The large majority of the studies were on PA (n = 59), while five focused on both PA and SB. No paper focused solely on SB. About half of the studies (n = 33) were conducted in the Western parts of Europe, most in the UK. A large number of the studies were conducted in the Nordic countries (n = 19). A few studies were comparative (n = 7), comparing two European countries or at least one European country with countries on other continents. Additional file 2 summarises description of the included studies.

We categorised the populations studied by country of origin, region, ethnicity or religion [see Additional file 2 and a more detailed division can be seen in Tables 1 and 2]. Most of the studies focused on more than one population. The main bulk of the studies focused on South Asian (n = 36), from India, Pakistan, or Bangladesh. These populations are especially important minority groups in the UK. Twelve studies focused on populations of Middle Eastern heritage, while nine studied African or Black African populations. Four studies focused on people of North African descent. The remaining populations studied were: South Americans (n = 3), East Africa, ns (n = 1), West Africans (n = 1). A few studies did not specify where the minority populations descended from (n = 8), but used such terms as ‘other origin’, ‘migrants’, or ‘Muslims’. 27 of the studies were either comparing ethnic minority groups and the majority populations, or studies of the general populations indicating ethnic background. Two studies were on indigenous population in the Nordic countries (Sami: n = 2)).

Most of the 63 studies included both men and women (n = 45). Of the remaining studies 14 focused on women and 4 on men. Adults were the most studied group (n = 35). The second largest group was children (n = 13), followed by adolescents (n = 6), young older adults (n = 4), and older adults (n = 2). Three studies focused on the general population, and age was not specified. The number of participants ranged from 92 to 14,485 (of which 1498 were immigrants) in the quantitative studies and 15–202 (a few focus group studies had high numbers of participants) in the qualitative studies.

Factors influencing physical activity/sedentary behaviour

We identified 183 distinct factors (Table 3) influencing PA and SB among ethnic minority groups in Europe. Of the identified factors, 60 were identified in qualitative studies and 54 were identified through quantitative studies only. The remaining factors were identified in both qualitative and quantitative studies, though many were predominantly identified through qualitative studies. The factors were often described as facilitators or barriers to PA and SB. Most factors were assigned to the Social & cultural environment cluster (n = 55 factors), followed by Psychosocial (n = 39), Physical environment & accessibility (n = 33), Migration context (n = 15), Institutional environment (n = 14), Social & material resources (n = 12), Health & health communication (n = 12), and finally Political environment (n = 3). The factors in the smallest cluster “Political environment” were identified only in qualitative studies. Qualitative studies were also strongly represented in most of the other clusters, but quantitative studies dominated the clusters “Migration context” and “Social & material resources”.
Table 3

Eight systems and 165 factors influencing PA and SB in ethnic minority populations (Study populations and references in bold are quantitative)

Health & health communication

Study population [ref]

Political environment

Study population [ref]

Social & cultural environment

Study population [ref]

Psychosocial

Study population [ref]

Institutional environment

Study population [ref]

Physical environment & opportunity

Study population [ref]

Social & material resources

Study population [ref]

Migration context

Study population [ref]

Health conditions

n = 7

Surinamese, & Indian [23] South Asian [2527] Pakistani & Indian [31] Asian [40] Multiethnic [47]

Local Political orientation

n = 3

Muslim [1820]

Gender

n = 23

South Asian [5] Muslim [1820, 28] General [21] African, Asian [22] Surinamese & Indian [23] Pakistani [24] South Asian [2527, 34] Diverse [29, 3539] Turkish [30] Pakistani & Indian [31] Moroccan [32] South Asian & Caribbean [33]

Knowledge of PA and Health

n = 16

North African [4] South Asian [5] Muslim [19, 20] Surinamese & Indian [23] South Asian [26, 40] Diverse [45] Pakistani [50] Turkish & Moroccan [52] General[54] Middle East [55] South Asian [61] Asian [62] General[63] Immigrants [64]

Demands of curriculum

n = 3

Muslim [19] Diverse [29] Diverse [45]

Sports facilities available

n = 11

South Asian [5] South Asian [18, 26, 27, 34] Diverse [29] Pakistani & Indian [31] Diverse [45] Multiethnic [47] Pakistani [50] Multiethnic [67]

Practicalities/responsibilities

n = 10

Pakistani [24] South Asian [26, 27, 40, 52] Muslim [28] Pakistani & Indian [31] Minority [42] Mixed [45] Sami [76]

Language

n = 9

South Asian [2527, 40, 49, 52] South Asian [54] Mixed [71, 72]

Physical health

n = 4

South Asian [26] Pakistani & Indian [31] South Asian [49] Pakistani [65]

Health care system adaptation

n = 2

Multiethnic [47] South Asian [58]

Religious requirements

n = 9

Muslim [20] South Asian [26, 34, 40, 41] Pakistani, Indian, [31] General [37] [40, 41] Diverse [42] Diverse [43]

Self-image

n = 11

Muslim [20] Surinamese & Indian [23] South Asian [26, 49, 52, 58] Asian [27] Multiethnic [47] Pakistani [50, 65] Turkish & Moroccan [53]

Head teacher’s attitude and resources

n = 3

Muslim [18–20]

Lack of appropriate activities

n = 10

South Asian [5, 61] Muslim [18] South Asian [26, 27, 40] immigrant [39] Minority [42] African [62] Pakistani [65]

Time constraints

n = 7

South Asian [5] South Asian [27, 40] Mixed [29] Pakistani & Indian [31] Immigrant [39] Pakistani [50]

Acculturation

n = 6

Mixed [21, 72] Turkish [30] Minority [42] Turkish & Moroccan [53] Turkish [59]

Religious fasting

n = 3

Muslim [19] South Asian [26, 27]

National political orientation

n = 1

Muslim [18]

Religion and culture

n = 8

South Asian [5] Muslim [18, 20] South Asian [26] Minority [43] General [44] Diverse [45] Mixed [46]

Knowledge of PA

n = 9

Surinamese & Indian [23] South Asian [26, 40, 58] Pakistani & Indian [31]

Pakistani [50,65] Middle East [55] African [62]

Priorities in school

n = 2

Diverse [29] South Asian [41]

Lack of culturally sensitive facilities

n = 7

Muslim [18, 19] South Asian [26, 27, 39, 52] Pakistani [31]

Occupation

n = 5

Pakistani & Indian [31] Immigrant [39] Multiethnic [47] Multiethnic [67] Mixed [72]

Country of birth

n = 5

Mixed [21,44, 46, 71, 75]

Healthcare support

n = 3

South Asian [26, 49, 58]

  

Commitments within family

n = 8

Muslim [20, 48] Pakistani [24] South Asian [27, 40] Pakistani & Indian [31] Immigrant [39] Multiethnic [47]

Dangers of environments and strangers

n = 7

South Asian [5] Pakistani [24] South Asian [26, 27, 34] Pakistani & Indian [31] [34] Mixed [45]

Exam pressure

n = 2

Muslim [20] Diverse[29]

Expenses

n = 6

Surinamese & Indian [23] South Asian [27, 34, 41] Diverse [45] South Asian [61]

Education

n = 4

Turkish [30] Immigrant [39] Iraqi [63] Multiethnic [67]

Racial harassment

n = 4

South Asian [27, 40] Minority [42] South Asian [54]

Mental health

n = 2

South Asian [70] Pakistani [65]

,

  

Modesty

n = 8

South Asian [5] Surinamese & Indian [23] South Asian [26, 27, 40, 49] Pakistani & Indian [31] Immigrant [38]

Ideas of ideal body

n = 6

South Asian [40, 41] Multiethnic [47] South Asian [54,61] African [62]

Occupational PA

n = 2

South Asian [27] Turkish [59]

Religious dress requirements

n = 6

Muslim [18, 20] African- Caribbean, Asian & South Asian [22] South Asian [27, 40] Immigrant [38]

Financial limitations

n = 4

South Asian [5] General[21] Immigrant [39] Multiethnic [67]

Time since migration

n = 4

Mixed [21, 72] South Asian & Surinamese [73] Tunisian [74]

Pain

n = 2

South Asian [26, 49]

  

Women as caregiver/mother

n = 7

South Asian [5] South Asian [26, 27, 40] Minority [42] Mixed [46] Muslim [48]

Confidence level

n = 6

South Asian [26, 49, 58] Pakistani [50,65] Turkish & Moroccan [53]

Traditional livelihood

n = 2

South Asian [27] Sami [66]

Transportation and infrastructure

n = 5

South Asian [26, 27] Moroccan [32] Multiethnic [47] Mixed [68]

Lack of parental time

n = 3

Pakistani [24] South Asian [34, 41]

Lack of knowledge of host culture

n = 3

General [21] South Asian [54] Mixed [64]

Primary health care

n = 2

Multiethnic [47] South Asian [58]

  

Ideals of behaviour

n = 7

Muslim [18, 28] Pakistani [24] South Asian [27, 34] Diverse [29] Immigrant [39]

Prevent disease

n = 6

South Asian [5] Surinamese & Indian [23] South Asian [25, 58] Minority [43] Pakistani [65]

Emphasis on competitive sports

n = 1

South Asian [34]

Climate

n = 5

Surinamese & Indian [23] South Asian [27] Pakistani & Indian [31] Moroccan [32] Mixed [69]

Taking time from family and gender role activities

n = 3

South Asian [5] African-Caribbean & South Asian [22] Pakistani & Indian [31]

Discrimination

n = 1

Mixed [46]

Lack of follow-up

n = 1

South Asian [58]

  

Family

n = 7

Muslim [18, 28] Surinamese & Indian [23] South Asian [26] Pakistani [50] Multi-ethnic [51] Turkish & Moroccan [52]

Karma/fatalism

n = 5

South Asian [5] Surinamese & Indian [23] Pakistani [31] South Asian [40, 52]

Lack of PA in school

n = 1

South Asian [34]

Unattractive neighbourhood

n = 4

Mixed [45] Multiethnic [47] Turkish [59] Mixed [68]

Income

n = 3

Migrants [35] Multiethic [47] Mixed [77]

Immigration history

n = 1

Mixed [37]

Poor physical fitness

n = 1

Pakistani [65]

  

Shame

n = 7

South Asian [5] Surinamese & Indian [23] South Asian [26, 27, 40] Pakistani & Indian [31] Immigrant [38]

Experience of PA/PE

n = 5

Immigrant [39] Multiethnic [47] Middle East [55] South Asian [58] Mixed [60]

Lack of extra-curricular staff

n = 1

Diverse [29]

Lack of gym instructor support

n = 4

Surinamese & Indian [23] South Asian [26, 52, 58]

Parental employment

n = 2

Pakistani [24] Mixed [75]

Stereotypes of children’s interests

n = 1

South Asian [34]

Stress

n = 1

Pakistani [65]

  

Cultural requirements

n = 6

Muslim [20] Pakistani [24] Diverse[29] South Asian [34] Turkish & Moroccan [53] General [54]

Goal setting

n = 5

Surinamese & Indian [23] South Asian [27, 40] Minority [42] Pakistani [50]

Limited school resources

n = 1

Diverse [29]

Living in urban area

n = 3

Mixed [37] South Asian [40,70]

social position

n = 2

Multiethnic [47] Pakistani & Indian [31]

Social ties with home country

n = 1

Tunisian [74]

Depression

n = 1

Pakistani [65]

  

Social acceptance of PA

n = 6

South Asian [5] African, Asian [22] South Asian [40] General [54, 56] Middle East [55]

Motivation

n = 5

South Asian [26, 40, 58] Immigrant [39] Pakistani [65]

PE choices unappealing

n = 1

Diverse [29]

Lack of women only facilities

n = 3

Muslim [18] Mixed [37] Immigrant [39]

Marital staus

n = 1

Turkish [30]

Generation

n = 1

Minorities [57]

Bad health

n = 1

Pakistani [65]

  

Social environment

n = 5

South Asian [27, 49] Multiethnic [47] Turkish & Moroccan [52] Minorities [57]

Notions of leisure-time PA

n = 4

South Asian [27] Pakistani & Indian [31] Moroccan [32] Sami [66]

Lack of separation work-leisure

n = 1

Sami [66]

Home environment

n = 3

Moroccan [32] Immigrant [36] Multiethnic [47]

Parental education level

n = 1

Mixed [77]

Host country

n = 1

Turkish [30]

    

Social support

n = 5

South Asian [25, 26, 58] Immigrant [39] Turkish & Moroccan [53]

Lack of enjoyment of PA

n = 4

Surinamese & Indian [23] Pakistani & Indian [31] Diverse [45] Muslim [48]

PE’s difference from other subjects

n = 1

Muslim [19]

Too much traffic

n = 2

Turkish [59] Mixed [45]

  

Age at time of migration

n = 1

Mixed [71]

    

Structural constraints in family

n = 5

Pakistani [24] Pakistani & Indian [31] Immigrant [39] Turkish [59] Mixed [60]

Health beliefs about PA

n = 3

Surinamese & Indian [23] Pakistani & Indian [31] General[54]

Negotiating participation

n = 1

Muslim [18]

Logistics of activities

n = 2

South Asian [26] Immigrant [39]

  

Migration

n = 1

South Asian [52]

    

Concepts of aging/generation

n = 5

South Asian [26, 27] Immigrant [36] Turkish & Moroccan [52] South Asian [61]

Attitudes

n = 3

Immigrants [56] South Asian [61] Pakistani [65]

  

Short-term activities

n = 2

South Asian [26] Pakistani & Indian [31]

  

Immigrant parent

n = 1

Mixed [77]

    

Parental attitudes to PA

n = 4

Muslim [18, 20, 28] Minorities [60]

Not the sporty type

n = 3

South Asian [27] Multiethnic [47] Pakistani [65]

  

Bad weather

n = 2

South Asian [5] Pakistani [24]

,

    
    

Lack of ‘exercise culture’

n = 4

Diverse [29] Pakistani & Indian [31] Turkish & Moroccan [52] Middle East [55]

PA as part of everyday life

n = 2

South Asian [25, 34]

  

Financial incentives

n = 2

Multiethnic [47]

    
    

Women not to be alone outside

n = 3

Muslim [28] Pakistani & Indian [31] General[54]

Interest in PA

n = 2

Mixed [29] Mixed [45]

  

Lack of information

n = 2

South Asian [52] Mixed [77]

    
    

Purposeful PA selfish

n = 3

South Asian [5] South Asian [49] General[54]

Perceived dis−/advantages of PA

n = 2

South Asian [49] Turkish & Moroccan [53]

  

Lack of open space

n = 2

South Asian [5] South Asian [34]

    
    

Age

n = 3

Muslim [20] Turkish [30] South Asian [58]

Self-efficacy

n = 2

Pakistani [50] Turkish & Moroccan [53]

  

Attractive environment

n = 1

Mixed [68]

    
    

Religious festivals

n = 3

Muslim [19] South Asian [26, 27]

Lack of knowledge of area

n = 2

Pakistani & Indian [31] South Asian [52]

  

Media portrayal of unsafe environment

n = 1

South Asian [34]

    
    

Religious prayer

n = 3

Muslim [19] South Asian [26, 27]

Perceived restrictions

n = 2

South Asian [49, 58]

  

Access to play area

n = 1

Mixed [60]

    
    

Peer group

n = 3

South Asian [26] Mixed [47] Turkish & Moroccan [52]

Views on age, lifestyle and health

n = 2

South Asian [49, 58]

  

Home appliances limit PA

n = 1

Moroccan [32]

    
    

Few active friends or family

n = 3

South Asian [27] Minority [42] Pakistani [50]

Fear of racism

n = 2

South Asian [54,61]

  

Lack of green space

n = 1

Mixed [29]

    
    

PA role models

n = 3

Muslim [20] Surinamese & Indian [23] Pakistani [50]

Preference of PA

n = 2

Multiethnic [47] South Asian [52]

  

Lack of safe storage in school for bikes/kit

n = 1

Mixed [29]

    
    

PA irrelevant to disease

n = 2

Pakistani & Indian [31] General [54]

Not gaining weight

n = 2

South Asian [49] Pakistani [65]

  

Few sidewalks

n = 1

Turkish [59]

    
    

Ethnic group

n = 2

South Asian & Caribbean [33] Minority [43]

Want to be fit

n = 2

South Asian [49] Pakistani [65]

  

Convenience of SB, e.g. TV

n = 1

Pakistani [24]

    
    

Ethnic minority concentration

n = 2

General [37] Mixed [80]

Concerns about safety

n = 1

South Asian [54]

  

Status of PE in some Muslim communities

n = 1

Muslim [20]

    
    

Habitus

n = 2

Minorities [57] Mixed [68]

Walking to school resisted

n = 1

Mixed [29]

  

Financial sanctions

n = 1

Multiethnic [47]

    
    

Social influence

n = 2

South Asian [52] Turkish & Moroccan [53]

Fear of falling

n = 1

South Asian [26]

  

Country

n = 1

Multiethnic [47]

    
    

Functional support

n = 2

South Asian [26, 52]

Lack of PA routine

n = 1

South Asian [26]

  

Structural barriers

n = 1

South Asian [5]

    
    

Facilitative relatives

n = 2

South Asian [26, 52]

Lack of intention

n = 1

Surinamese & Indian [23]

  

Crime

n = 1

Turkish [59]

    
    

Social network

n = 2

Mixed [46, 72]

Ability to use health care

n = 1

Mixed [72]

        
    

Preferred mode of transportation

n = 2

Immigrant [38] Multiethnic [67]

Body consciousness increased during adolescence

n = 1

Muslim [20]

        
    

Religious community

n = 2

Diverse [45] Multiethnic [47]

Religious consciousness increased during adolescence

n = 1

Muslim [20]

        
    

Stereotypes

n = 1

Minority [42]

Lack of PA skills

n = 1

Pakistani [50]

        
    

Parental marital status

n = 1

General[37]

Values associated with PA

n = 1

Pakistani [50]

        
    

Car use

n = 1

South Asian [34]

Behavioural control

n = 1

Pakistani [65]

        
    

Inactive parental lifestyle

n = 1

South Asian [34]

Identity

n = 1

Pakistani [65]

        
    

Increased sedentary activities

n = 1

South Asian [34]

          
    

Social resources

n = 1

Minorities [60]

          
    

Parents’ participation in organised sports

n = 1

Minorities [60]

          
    

Activities in own community

n = 1

South Asian [40]

          
    

Work ethics

n = 1

South Asian [40]

          
    

Historical experiences and adaptations

n = 1

Minorities [57]

          
    

Children as incentive to be active

n = 1

South Asian [27]

          
    

Partner’s or family disproval

n = 1

South Asian [27]

          
    

Behaviour of others

n = 1

Turkish & Moroccan [53]

          
    

Gym based exercise unfamiliar

n = 1

South Asian [52]

          
    

Collectivist norms

n = 1

South Asian [52]

          
    

Overprotective family

n = 1

South Asian [52]

          
    

Traditional authorities

n = 1

Surinamese & Indian [23]

          
    

Symbolic meaning of certain foods

n = 1

Surinamese & Indian [23]

          
    

Attitude of peers

n = 1

Musilim [18]

          
    

Traditional power relations

n = 1

Musilim [18]

          

There were some similarities and differences in clusters of factors influencing PA and SB across different ethnic minority groups (Table 3). For example, “Social and cultural environment”, “Social and material resources” and “Migration context” were identified in many of the study populations and studies with mixed populations. Many of the factors in the clusters “Physical environment and accessibility”, “Psychosocial and institutional environment” and “Health and health communication” were common in studies conducted among South Asians, the largest group in the review, but also African, Caribbean, Turkish and mixed. Qualitative studies that focused on Muslim groups were represented in most clusters except “Migration context” and “Social and material resources”.

Clusters

“Social & cultural environment”

The “Social & cultural environment” cluster included most factors (55 factors). The most cited factor was gender [5, 1839] (Table 2). Gender, as a factor that influences PA and SB in ethnic minority groups, span different notions, and included cultural and religious notions of gender, moralities related to gender, and as well as social expectations and gender roles.

Factors related to religion recurred often as well. These included: religious requirements [20, 26, 31, 34, 37, 4043] and religion and culture [5, 18, 20, 26, 4346]. Following the factors were, commitments within family [20, 24, 27, 31, 39, 40, 47, 48] and modesty [5, 23, 26, 27, 31, 38, 40, 49]. Other factors related to gender, family, religious and cultural issues were: women as caregiver/mother [5, 26, 27, 40, 42, 46, 48], ideals of behaviour [18, 24, 2729, 34, 39], family [18, 23, 26, 28, 5052] and shame [5, 23, 26, 27, 31, 38, 40]. The broader factors, religious requirements and religion and culture, encompassed religious requirements of dressing, as well as degree of religiosity or piety.

The cluster also included factors relating to cultural requirements [20, 24, 29, 34, 53, 54], social acceptance of PA [5, 22, 40, 5456], social environment [27, 47, 49, 52, 57], social support [25, 26, 39, 53, 58], structural constraints in family [24, 31, 39, 59, 60] and concepts of age/aging [26, 27, 36, 52, 61]. Cultural requirements included ideals of behaviour and morality, as well as commitments of attending religious ceremonies and notions of the relationship between genders. The factor social acceptance of PA covered more specific factors. For instance, Babakus et al. [5] described that education about Muslim faith can be a motivating factor as PA is seen as central to the Muslim way of life.

Some studies included the factors: parental attitudes to PA [18, 20, 28, 60], lack of ‘exercise culture’ [29, 31, 52, 55], women not to be alone outside [28, 31, 54], purposeful PA selfish [5, 49, 54], age [20, 30, 58], religious festivals [19, 26, 27], religious prayer [19, 26, 27], peer group [26, 47, 52], few active friends or family [27, 42, 50], and PA role models [20, 23, 50]. The remaining factors were found in only one or two studies. Many studies were on South Asian and Muslim women, but also other groups.

“Psychosocial”

The “Psychosocial” cluster included individually held factors. Knowledge of PA and health [4, 5, 19, 20, 23, 26, 40, 45, 50, 52, 54, 55, 6164], the factor included in most studies, covers knowledge, notions and ideas about what constitutes PA and the relationship between health and PA. Self-image [20, 23, 26, 27, 47, 49, 50, 52, 53, 58, 65], which encompasses different notions of who one is and should be, was mainly reported in qualitative studies.

The cluster also included factors such as knowledge of PA [23, 26, 31, 40, 50, 55, 58, 62, 65], dangers of environment and strangers [5, 24, 26, 27, 31, 34, 45], ideas of ideal body [40, 41, 47, 54, 61, 62], confidence level [26, 49, 50, 53, 58, 65], prevent disease [5, 23, 25, 43, 58, 65], notions of karma/fatalism [5, 23, 31, 40, 52], experience of PA/PE [39, 47, 55, 58, 60], goal setting [23, 27, 40, 42, 50], motivation [26, 39, 40, 58, 65], notions of leisure-time PA [27, 31, 32, 66], lack of enjoyment of PA [23, 31, 45, 48], health beliefs about PA [23, 31, 54], attitudes [56, 61, 65], not the sporty type [27, 47, 65]. The remaining factors were found in only one or two articles. Study populations were mixed in relation to gender.

“Physical environment & accessibility”

Sports facilities available [5, 18, 26, 27, 29, 31, 34, 45, 47, 50, 67], lack of appropriate activities [5, 18, 26, 27, 39, 40, 42, 61, 62, 65] and lack of culturally sensitive facilities [18, 19, 26, 27, 31, 39, 52] were the most widely cited PA and SB factors in this cluster. Lack of appropriate activities and lack of culturally sensitive facilities were often interwoven with gender issues, as for instance whether or not an activity was appropriate for women or whether women and men could exercise separately. Lack of women only facilities [18, 37, 39] was mentioned as a factor as well.

This cluster also included expenses [23, 27, 34, 41, 45, 61], religious dress requirements [18, 20, 22, 27, 38, 40], transportation and infrastructure [26, 27, 32, 47, 68], climate [23, 27, 31, 32, 69], unattractive neighbourhood [45, 47, 59, 68], lack of gym instructor support [23, 26, 52, 58], living in urban area [37, 40, 70], and home environment [32, 36, 47]. The remaining 20 factors were found in only one or two studies. Study populations were mixed in relation to gender.

“Migration context”

The main factor in the “Migration context” cluster was language [2527, 40, 49, 52, 54, 71, 72], meaning a lack or poor knowledge of the language of the host country. Language was seen as having an impact on PA and SB in several ways. As a barrier to get access of knowledge about PA, SB and health, as well as information on when and where to do PA. The second most cited factor in this cluster was acculturation [21, 30, 42, 53, 59, 72], meaning the ways minorities become part of the wider society. “Acculturation” was often related to other factors such as time since migration [21, 7274], generation [57], and immigration history [37].

Other factors grouped under this cluster included country of birth [21, 44, 46, 71, 75] (implying cultural background, but also host country’s attitudes towards immigrants from a specific country), racial harassment [27, 40, 42, 54], and lack of knowledge of host culture [21, 54, 64]. The remaining seven factors were only found in only study each. Study populations were mixed in relation to gender.

“Institutional environment”

The cluster “Institutional environment” included factors related to school and work environment. In schools, demands of curriculum [19, 29, 45] were seen as having an impact on PA both because schools prioritise other subjects than physical education (PE) [19], and because parents value homework over leisure time PA [45]. Head teacher’s attitude and resources [1820] also had an impact on PA. Teachers could choose whether or not to let ethnic minority pupils participate on their own terms, i.e. separating boys and girls, or allowing ethnic dress requirements, and because limited resources can make it harder to prioritise PA or extra-curricular activities. Other factors included priorities in school [29, 41], exam pressure [20, 29], occupational PA [27, 59] and traditional livelihood [27, 66]. Many studies focused on Muslim women and girls.

“Social and material resources”

Practicalities/responsibilities [24, 2628, 31, 40, 42, 45, 52, 76] were the most cited factors assigned to the cluster “Social and material resources.” The cluster also consisted of time constraints [5, 27, 29, 31, 39, 40, 50], occupation [31, 39, 47, 67, 72], education [30, 39, 63, 67], financial limitations [5, 21, 39, 67], lack of parental time [24, 34, 41], taking time from family and gender role activities [5, 22, 31], and income [35, 47, 77]. The remaining four factors were only reported in one or two studies. Study populations were mixed in relation to gender.

“Health and health communication”

This cluster included health conditions [23, 2527, 31, 40, 47], physical health [26, 31, 49, 65], religious fasting [19, 26, 27], healthcare support [26, 49, 58], mental health [65, 70], pain [26, 49] and primary health care [47, 58]. The remaining five factors were found in one article. The majority of studies focused on women.

“Political environment”

This is the cluster with the smallest number of factors: local political orientation [1820], health care system adaptation [47, 58] and national political orientation [18]. Local and national political orientation were seen as having an impact on PA and SB in ethnic minority groups by the willingness to make adaptations to better suit minority populations. Health care system adaptation had similar impact on PA and SB, by conveying the message of PA and health in ways adapted to ethnic minority groups. Many studies focused on Muslim women and girls.

Discussion

The main aims of this study were to identify factors influencing physical activity and sedentary behaviour among ethnic minority groups living in Europe, uncover gaps in the literature, and to suggest priorities for future research. The review extracted 183 factors that were grouped into eight clusters. The “Social & cultural environment” and “Psychosocial” were the clusters containing most factors.

An important finding of our study was that cultural and religious issues, in particular those related to gender issues, were recurring factors across the clusters. Among these were cultural ideas of the body. Ideas of healthy ways to move and appropriateness of exposing parts of the body to perform physical activity are culturally loaded and tend to vary according to age, gender and roles/responsibilities within the family. For instance, research among adolescents has shown that consciousness of one’s own body and religious consciousness evolve during these years, and affect individual’s involvement and meaning of PA [20]. Importantly, cultural and religious factors can both hinder and facilitate PA. For example, religious requirements on how to dress [18, 20, 22, 27, 38, 40] and limitations on spending time with the opposite gender might hinder PA, but staying fit and walking to religious sites for prayer were sometimes religious merits [27]. Other cultural issues involved ideas of femininity [43], religious or traditional ideas of ideal behaviour and attitudes related to leisure time. Moreover, there was the impact of lack of gender-segregated facilities [27, 39, 61]. Being female is not necessarily a barrier to PA in Muslim populations, but if there are no ways in which women can be active without encountering men, this might lead to women being less active. Not being able to separate between Islamic ideals (which is not against women being active) and particular cultural traditions of some Muslim populations (which might be counter to PA among women) was one factor of PA identified [20]. Therefore, understanding how religion and culture or tradition interact with other factors requires more in-depth study.

In stating that there are important factors to be found in the interchange between “gender,” “culture” and “religion,” it is vital to keep in mind that many of the studies have been undertaken among Muslim groups, thus the findings of this review reflect the populations studied.

The study showed that there were also many factors related to knowledge and information across the clusters, such as lack of knowledge and information about PA and the relationship between health and PA [4, 5, 20, 23, 26, 31, 40, 45, 50, 55, 58, 6165]. Lack of knowledge and information about facilities in own community [31, 52, 77] were reported as well. Other emerging factors were lack of knowledge of new culture and familiarity with wider community [21, 54, 64].

Language capabilities [2527, 40, 49, 52, 54, 71, 72] had impact on access to information and knowledge about opportunities for PA in local areas and recommendations for PA. Additionally, lack of fluency in language can make it harder to follow PA classes/courses.

The review indicated that ethnic minority groups are influenced by many of the same factors as majority populations, such as age, knowledge and physical environment [15, 78, 79], but the processes underlying these factors (culture, religion, lay models etc.) were distinctive for ethnic minority groups. Specific factors for ethnic minority groups, such as cultural, religious, and/or traditional values, perceptions and ideas (associated with PA, sedentary behaviour and body) emerged. The review showed that there are divergent notions of what constitutes physical activity and exercise [27, 31, 32, 66] and how different activities might relate to health [4, 5, 20, 26, 31, 40, 45, 50, 52, 54, 55, 61, 64]. Culturally dependent knowledge, notions and ideas of the physical activity and health and how they are related were among the most important reasons for not being active. For instance, some ethnic groups viewed physical activity as detrimental for health, especially for women and the elderly. Thus, it is important to gain knowledge about the cultural ideas of physical activity in different ethnic minority groups, but also to develop culturally sensitive information about the health benefits of physical activity, to create effective interventions and policies.

Strengths and limitations of the review

This is the first systematic mapping review that has described factors influencing PA and SB among a diverse ethnic minority groups living in Europe. One difference between this review and earlier reviews is the method used in synthesizing the findings. In this review, we have used a novel categorization based on clustering factors. This approach transcends existing models by aiming at better capturing the complexity of the system of factors influencing behaviour [10, 13]. Another strength of the study is that the study design included both quantitative and qualitative published European literature. The review indicated that quantitative and qualitative studies contribute to our understanding of PA and SB among ethnic minority groups by providing somewhat different sets of factors. Qualitative studies used more explorative designs about PA and SB in ethnic groups, and yielded richer and more detailed information about the inter-relationship between factors and clusters. One challenge in this review is that the categorisation of ethnic groups varied widely between the different studies, making it difficult to compare the findings.

The review indicates that there is more evidence for the role of individual level factors like gender, knowledge of PA and health, and health conditions compared with environmental factors. This tendency might in part stem from the place of the individual in the “Western” society. However, it is also important to note that the number of studies citing each factor is not necessarily an indication of the importance of those factors. Rather, it tells us is how many studies have selected to focus on each factor. For instance, the fact that few factors related to political environment have been found does not mean that environmental factors are not important, but there has been less focus on them.

The importance of religion and gender issues may be due to the fact that many studies have been conducted on populations with Islamic faith. In order to further explore factors related to PA and SB among ethnic minorities, more studies on populations of different religious affiliation (for example, Hinduism, Catholicism) are needed.

Implication of the findings

The literature review indicates that both PA and SB among ethnic minority groups in Europe are influenced by a wide variety of factors that are related and cut across different clusters of influence. Our findings support the need of adopting a systems-based framework [10] to capture the complexity of PA and SB among ethnic minority populations. Studies adopting a qualitative research design provided a richer understanding of underlying factors related to PA and SB.

The literature review indicates that comparative studies are limited. One recommendation from the review is that there is a need for systematic comparative research across Europe to shed light on the processes in which similar factors drive PA and SB behaviours on specific groups in different national and regional settings. Most studies included population from South Asia and Muslim populations, but as the European population is changing there is the need to further research on other ethnic groups, for example, asylum seeking groups from Somalia, Eritrea and Syria.

The majority of the studies were conducted in the Western part of Europe, mainly in the UK, and the Nordic countries. This was reflected in the groups included in the review, which do not represent the diversity of ethnic minority groups and religious populations living in Europe. This calls for a broadening of the research scope to include all parts of Europe.

Finally, the literature review indicates that there are very few studies on SB among ethnic minority groups in Europe. SB is a fairly new area of research and thus methods may not have not been adapted to ethnic minorities. As the relevance of SB for health outcomes is increasingly documented [15, 78], further research on this topic needs to specifically address ethnic minority groups.

Conclusions

This systematic review identified 183 factors influencing PA and SB across some ethnic minority and religious groups (Muslim) living in Europe. Factors were grouped into eight clusters following a data driven approach. The most recurrent factors (gender, religion, cultural requirements and knowledge) were part of the clusters ‘Social & cultural environment’ and ‘Psychosocial’.

The review indicated that there are several gaps in the literature related to the ethnic minority populations studied, the countries where the studies have been conducted, paucity of comparative studies and lack of attention towards SB.

The review showed that there are some specific factors influencing PA and SB among ethnic minority groups. It is important to further address these factors in order to plan and implement effective interventions.

Abbreviations

DEDIPAC KH: 

Determinants of Diet and Physical Activity Knowledge Hub

NCDs: 

Non-communicable diseases

PA: 

Physical Activity

SB: 

Sedentary Behaviour

Declarations

Acknowledgements

The authors wish to thank the entire Work Package 2.4 team of the DEDIPAC KH.

Funding

The preparation of this paper was supported by the Determinants of Diet and Physical Activity (DEDIPAC) Knowledge Hub. The DEDIPAC project is supported by the Joint Programming Initiative ‘Healthy Diet for a Healthy Life’, a research and innovation initiative of European Union member states and associated countries. The funding agencies supporting this work are (in alphabetical order of participating Member State): Norway: Norwegian Research Council; The Netherlands: the Netherlands Organisation for Health Research and Development; The United Kingdom: The Medical Research Council.

Availability of data and materials

Not applicable.

Authors’ contributions

All authors conceptualised and designed the study. LJL, LT, GrR and GR screened and extracted the data. LJL drafted the manuscript. All authors reviewed draft versions of the manuscript and provided suggestions and critical feedback. All authors have made a significant contribution to this manuscript and approved the final manuscript.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Norwegian School of Sport Sciences
(2)
Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences
(3)
Department of Public Health, Academic Medical Centre, University of Amsterdam
(4)
Public Health Section, School of Health and Related Research, University of Sheffield
(5)
Department of Nutrition, University of Oslo
(6)
Consumption Research Norway – SIFO, Oslo and Akershus University College of Applied Sciences

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Copyright

© The Author(s). 2017

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